女性压力性尿失禁尿道关闭功能和尿道膀胱连接部移动度超声尿动力学研究

Urethral closure function and mobility of urethrovesical junction in female urinary stress incontinence by sonographic urodynamic study

目的 应用超声尿动力学研究女性压力性尿失禁的尿道关闭功能和尿道膀胱连接部移动度。方法 对 40例压力性尿失禁患者和 2 2例正常人作超声尿动力学检查。标化测定连接部移动度 (UVJ M )、尿道最大关闭压 (MCP)、尿道功能性长度 (FL)和腹压漏尿点压 (ALPP)。除外不稳定膀胱和尿道。结果 尿失禁组参量UVJ M大于正常组 (P <0 .0 1) ;参量ALPP、MCP、FL低于正常组 (P <0 .0 1)。尿失禁组分为ALPP≤ 5 5cmH2 O组 (n =18)和ALPP >5 5cmH2 O组 (n =2 2 )。前组UVJ M、MCP、FL显著低于后组 (P <0 .0 1) ,尿失禁Ⅱ～Ⅲ度比例数高于后组 (78%对 5 0 % ,P <0 .0 5 ) ,合并子宫脱垂或阴道膨出比例数低于后组 (5 4%对 91% ,P <0 .0 1)。结论 压力性尿失禁组同时存在尿道关闭功能和连接部移动度异常。ALP≤ 5 5cmH2 O组以尿道关闭功能损害为主 ,ALPP >5 5cmH2

Objective To study the urethral closure function and urethrovesical mobility in female urinary stress incontinence (SUI) by sonographic urodynamics. Methods Forty patients with SUI and 22 continent women as a control group underwent sonographic urodynamics examination. The unstable bladder and unstable urethra were excluded from this study. The mobility of urethrovesical junction (UVJ M) was measured by transperineal sonography while the bladder volume was controlled at 250 ml and the intravesical pressure at 250 cmH 2O by urodynamic examination. Maximal urethral closure pressure (MCP), functional urethral length (FL), abdominal leak point pressure (ALPP) during valsava maneuver were obtained by urodynamic technique. Results There were significant differences ( P < 0.01 ) in anatomic and functional parameters between SUI group and control group. The parameter of UVJ M in SUI group was higher than that in control group, while the parameters of MCP, FL and ALPP were markedly lower than those in control group. The SUI group was divided into two subgroups: ALPP≤55 cmH 2O group (n=18) and ALPP>55 cmH 2O group (n=22). The parameters of UVJ M, MCP and FL in the former were lower than those in the latter ( P <0.01). The rate of patients with Ⅱ Ⅲ degree incontinence in the former group was higher (78% vs 50%, P <0.05 ), and the rate of patients associated with pelvic floor relaxation was lower (54% vs 91%, P <0.01). Conclusion There were abnormal urethral closure function and abnormal mobility of UVJ in SUI group. The damage of urethral closure function was the main change in ALPP≤55 cmH 2O group, and hypermobility of UVJ in ALPP>55 cmH 2O group. (Shanghai Med J, 543 546)