虚拟现实研究女性压力性尿失禁膀胱尿道形态

Application of three dimensional virtual reality in study on vesicai morphology in female SUI

目的采用虚拟现实技术重建膀胱尿道并探讨膀胱尿道形态的变化与压力性尿失禁的相关性。方法15例有典型临床表现并经尿动力确诊为压力性尿失禁患者和15例正常对照者行核磁共振扫描，采用虚拟现实技术对膀胱尿道等结构进行三维立体重建，观测静态和Valsalva动作时膀胱尿道后角、尿道倾斜角和膀胱颈移动度。结果压力性尿失禁组静息和应力状态下膀胱尿道后角分别为121．9±6．8°和148．2±30．1°，均大于对照组的101．3±5．5°和113．5±2．9°，经比较差异均有统计学意义（t分别为9．049、4．431，均P〈0．05），压力性尿失禁组静息和应力状态下尿道倾斜角分别为22．6±5．0°和38．8±14．7°，均大于对照组的7．7±1．4°和21．7±1．4°，经比较差异均有统计学意义（t分别为8．599、4．276，均P〈0．05）。压力性尿失禁组膀胱颈移动度为14．2±6．2mm，大于对照组的7．7±1．4mm，经比较差异有统计学意义（t=3．949，P〈0．05）。结论虚拟现实系统是研究压力性尿失禁患者膀胱尿道形态学的有效方法，可以观察到压力性尿失禁患者膀胱颈后尿道明显下移。

Objective To reconstruct the bladder and urethra model using three-dimensional virtual reality technology and investigate relation between morphologic alterations of the bladder and urethra and stress urinary incontinence（SUI）. Methods 15 patients with typical clinical manifestations and diagnosed by urodynamie testing as SUI and other 15 healthy women underwent MR imaging examination. Threedimensional virtual reality technology was adopted to reconstruct three-dimension （3-D）models of pelvic bones, bladder, urethra and musculi obturator internus. Using the 3-D models, posterior urethrovesical angle （PUV angle）, urethral inclination angle and mobility of the bladder neck at rest and Valsalva effort at maximal straining of women in the two groups were observed and compared. Results In the SUI group, the PUV angles of the patients at rest and Valsalva effort at maximal straining were 121.9 ±6.8° and 148.2±30.1°, which were greater than those in the control group （101.3 ± 5.5° and 113.5 ± 2.9°） and there were significant differences between the two groups （t = 9. 049, 4. 431 respectively, both P 〈 0.05 ）. The urethral inclination angle of patients in the SUI group at rest and Valsalva effort at maximal straining were 22.6±5.0°and 38.8° respectively,which were greater than those in the control group （ 7.7± 1.4° and 21.7 ± 1.4° respectively） and the differences were significant （ t = 8. 599, 4. 276 respectively, both P 〈 0.05）. In mobility of the bladder neck, there was a significant difference between the two groups （ 14.2 ± 6.2mm vs 7.7± 1.4mm, t = 3. 949, P 〈 0.05 ）. Conclusion Virtual reality technology is an innovative and effective method to reveal significant morphologic alterations in bladder and urethra of patients with SUI , by which, significant down displacement of bladder neck and posterior uthra in SUI could be seen.