Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery ...Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen women (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who delivered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced maternal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 3 and 6 months postpartum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclusion: Recovery of pelvic floor function following delivery may be delayed in women of advanced maternal age at first delivery because of the damage to the pelvic floor during pregnancy and vaginal delivery, resulting in increase in the incidence of stress urinary incontinence.展开更多
Objective:To investigate the value of(VTIQ)shear wave elastography in the diagnosis of pelvic floor dysfunction.Methods:20 patients with pelvic floor dysfunction and 40 healthy volunteers were enrolled in and devided ...Objective:To investigate the value of(VTIQ)shear wave elastography in the diagnosis of pelvic floor dysfunction.Methods:20 patients with pelvic floor dysfunction and 40 healthy volunteers were enrolled in and devided into the pelvic floor dysfunction(PFD)group and the control group.20 cases in the normal non-fertile(NNF)group and the normal fertile(NF)group respectively were including in the control group.The Young's modulus of puborectalis(PR)in three groups was measured by virtual touch tissue imaging quantification(VTIQ)at different states.The Young's modulus of PR and their differences in the three groups and between groups were compared and calculated.Receiver-operating characteristic curve(ROC)analyses were performed to assess the diagnostic value of VTIQ,and the area under the curve(AUC)was compared.Results:Young's modulus of PR at resting-state,maximun rectal state and Vasalva state in NNF group and NF group were statistical significance(all P<0.05).Young's modulus of maximun rectal state was higher than that of resting-state and Vasalva state in PFD group(P<0.05).There was no significant difference in Young's modulus between the resting-state and Vasalva state in the PFD group(P>0.05).Difference of PR Young's modulus between resting status and maximun rectal state and that between resting status and Vasalva state were of statistical significance among the three groups(all P<0.05).ROC curves analyses indicated that the AUC,cut-off value,sensitivity,specificity and Youden index of the difference between the Young's modulus of resting status and maximun rectal state measured by VTIQ in control group and PFD group were 0.788,35.45kPa,91.67%,57.14%,0.488,espectively.The AUC,cut-off value,sensitivity,specificity and Youden index of the difference between the Young's modulus of resting status and Vasalva state measured by VTIQ in control group and PFD group were 0.799,14.00kPa,63.89%,85.71%,0.496,respectively.There was no significant difference in AUC between the two groups(Z=0.130,P>0.05).Conclusion:VTIQ technology is an effective method to quantitatively assess the biomechanical properties of PR.The effect of labor on the puborectalis muscle was not significant.The increase of Young's modulus of passive stretching in vasalva state was not significant in patients with pelvic floor dysfunction.The difference between resting status and maximun rectal state and difference between resting status and Vasalva state is more advantageous to the diagnosis of pelvic floor dysfunction disorder.展开更多
Objective: To study the ultrasonic quantitative evaluation of pelvic floor characteristics in patients with stress urinary incontinence and the correlation with extracellular matrix remodeling and apoptosis. Methods: ...Objective: To study the ultrasonic quantitative evaluation of pelvic floor characteristics in patients with stress urinary incontinence and the correlation with extracellular matrix remodeling and apoptosis. Methods: Patients with stress urinary incontinence who received surgical treatment in Xuzhou Central Hospital between February 2015 and April 2017 were selected as the SUI group of the research, female healthy volunteers who received physical examination during the same period were selected as the control group A of the research, and patients who received total hysterectomy for benign disease during the same period were selected as the control group B of the research. The ultrasound parameters of pelvic floor characteristics of SUI group and control group A were determined before surgery, and the contents of collagen metabolism indexes, extracellular matrix metabolism indexes and apoptosis genes of SUI group and control group B were determined after surgery. Results:Pelvic floor ultrasound parameters BND, R-RVA, V-RVA and UR levels of SUI group were higher than those of control group A;Col-I and Col-II contents as well as Fibulin-5, LOX and LOXL1 mRNA expression in pelvic floor tissue of SUI group were significantly lower than those of control group B and negatively correlated with pelvic ultrasound parameter BND while ICTP content as well as Calpain1, Calpain2, Caspase-3, LC3-II and Beclin-1 mRNA expression was significantly higher than those of control group B and positively correlated with pelvic floor ultrasound parameter BND. Conclusion: The patients with stress urinary incontinence have the ultrasonic characteristics of weak pelvic support and enhanced urethral activity, and the abnormal collagen metabolism and excessive apoptosis are closely related to the changes of pelvic floor.展开更多
目的探讨肛提肌未发生撕脱时,盆腔脏器脱垂(pelvic organ prolapse,POP)的初产妇肛提肌裂孔形态是否发生异常改变。方法收集经阴道分娩且肛提肌未发生撕脱的初产妇107例,出现POP的65例为POP组,未出现POP的42例为对照组。应用经会阴4D盆...目的探讨肛提肌未发生撕脱时,盆腔脏器脱垂(pelvic organ prolapse,POP)的初产妇肛提肌裂孔形态是否发生异常改变。方法收集经阴道分娩且肛提肌未发生撕脱的初产妇107例,出现POP的65例为POP组,未出现POP的42例为对照组。应用经会阴4D盆底超声采集在静息、最大瓦氏状态下两组初产妇肛提肌裂孔形态参数:肛提肌裂孔前后径(LHAP)、肛提肌裂孔左右径(LHLD)、肛提肌裂孔周径(LHC)、肛提肌裂孔面积(LHA)。结果静息状态下POP组及对照组LHAP、LHLD、LHC、LHA比较,差异无统计学意义(P>0.05);最大瓦氏状态下POP组的LHAP、LHLD、LHC、LHA较对照组均增大,差异有统计学意义(P<0.05),当最大瓦氏状态下LHA>18.84 cm^(2),诊断初产妇发生POP的敏感度为73.8%,特异度95.2%,AUC为0.912。结论肛提肌未撕脱的初次经阴道分娩的POP产妇也会发生肛提肌损伤。4D盆底超声下肛提肌裂孔形态的改变可反映肛提肌有无损伤及损伤程度,尤其最大瓦氏状态下肛提肌裂孔的面积与POP相关性很好。展开更多
文摘Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen women (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who delivered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced maternal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 3 and 6 months postpartum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclusion: Recovery of pelvic floor function following delivery may be delayed in women of advanced maternal age at first delivery because of the damage to the pelvic floor during pregnancy and vaginal delivery, resulting in increase in the incidence of stress urinary incontinence.
基金Youth Project of Hainan Natural Science Foundation(No.819QN352)。
文摘Objective:To investigate the value of(VTIQ)shear wave elastography in the diagnosis of pelvic floor dysfunction.Methods:20 patients with pelvic floor dysfunction and 40 healthy volunteers were enrolled in and devided into the pelvic floor dysfunction(PFD)group and the control group.20 cases in the normal non-fertile(NNF)group and the normal fertile(NF)group respectively were including in the control group.The Young's modulus of puborectalis(PR)in three groups was measured by virtual touch tissue imaging quantification(VTIQ)at different states.The Young's modulus of PR and their differences in the three groups and between groups were compared and calculated.Receiver-operating characteristic curve(ROC)analyses were performed to assess the diagnostic value of VTIQ,and the area under the curve(AUC)was compared.Results:Young's modulus of PR at resting-state,maximun rectal state and Vasalva state in NNF group and NF group were statistical significance(all P<0.05).Young's modulus of maximun rectal state was higher than that of resting-state and Vasalva state in PFD group(P<0.05).There was no significant difference in Young's modulus between the resting-state and Vasalva state in the PFD group(P>0.05).Difference of PR Young's modulus between resting status and maximun rectal state and that between resting status and Vasalva state were of statistical significance among the three groups(all P<0.05).ROC curves analyses indicated that the AUC,cut-off value,sensitivity,specificity and Youden index of the difference between the Young's modulus of resting status and maximun rectal state measured by VTIQ in control group and PFD group were 0.788,35.45kPa,91.67%,57.14%,0.488,espectively.The AUC,cut-off value,sensitivity,specificity and Youden index of the difference between the Young's modulus of resting status and Vasalva state measured by VTIQ in control group and PFD group were 0.799,14.00kPa,63.89%,85.71%,0.496,respectively.There was no significant difference in AUC between the two groups(Z=0.130,P>0.05).Conclusion:VTIQ technology is an effective method to quantitatively assess the biomechanical properties of PR.The effect of labor on the puborectalis muscle was not significant.The increase of Young's modulus of passive stretching in vasalva state was not significant in patients with pelvic floor dysfunction.The difference between resting status and maximun rectal state and difference between resting status and Vasalva state is more advantageous to the diagnosis of pelvic floor dysfunction disorder.
文摘Objective: To study the ultrasonic quantitative evaluation of pelvic floor characteristics in patients with stress urinary incontinence and the correlation with extracellular matrix remodeling and apoptosis. Methods: Patients with stress urinary incontinence who received surgical treatment in Xuzhou Central Hospital between February 2015 and April 2017 were selected as the SUI group of the research, female healthy volunteers who received physical examination during the same period were selected as the control group A of the research, and patients who received total hysterectomy for benign disease during the same period were selected as the control group B of the research. The ultrasound parameters of pelvic floor characteristics of SUI group and control group A were determined before surgery, and the contents of collagen metabolism indexes, extracellular matrix metabolism indexes and apoptosis genes of SUI group and control group B were determined after surgery. Results:Pelvic floor ultrasound parameters BND, R-RVA, V-RVA and UR levels of SUI group were higher than those of control group A;Col-I and Col-II contents as well as Fibulin-5, LOX and LOXL1 mRNA expression in pelvic floor tissue of SUI group were significantly lower than those of control group B and negatively correlated with pelvic ultrasound parameter BND while ICTP content as well as Calpain1, Calpain2, Caspase-3, LC3-II and Beclin-1 mRNA expression was significantly higher than those of control group B and positively correlated with pelvic floor ultrasound parameter BND. Conclusion: The patients with stress urinary incontinence have the ultrasonic characteristics of weak pelvic support and enhanced urethral activity, and the abnormal collagen metabolism and excessive apoptosis are closely related to the changes of pelvic floor.
文摘目的探讨肛提肌未发生撕脱时,盆腔脏器脱垂(pelvic organ prolapse,POP)的初产妇肛提肌裂孔形态是否发生异常改变。方法收集经阴道分娩且肛提肌未发生撕脱的初产妇107例,出现POP的65例为POP组,未出现POP的42例为对照组。应用经会阴4D盆底超声采集在静息、最大瓦氏状态下两组初产妇肛提肌裂孔形态参数:肛提肌裂孔前后径(LHAP)、肛提肌裂孔左右径(LHLD)、肛提肌裂孔周径(LHC)、肛提肌裂孔面积(LHA)。结果静息状态下POP组及对照组LHAP、LHLD、LHC、LHA比较,差异无统计学意义(P>0.05);最大瓦氏状态下POP组的LHAP、LHLD、LHC、LHA较对照组均增大,差异有统计学意义(P<0.05),当最大瓦氏状态下LHA>18.84 cm^(2),诊断初产妇发生POP的敏感度为73.8%,特异度95.2%,AUC为0.912。结论肛提肌未撕脱的初次经阴道分娩的POP产妇也会发生肛提肌损伤。4D盆底超声下肛提肌裂孔形态的改变可反映肛提肌有无损伤及损伤程度,尤其最大瓦氏状态下肛提肌裂孔的面积与POP相关性很好。
