Transrectal sonographic investigation of urethral and paraurethral structures in women with stress urinary incontinence.

Transrectal sonography of the urethra was used in 14 asymptomatic volunteers, 37 women with frequency-urgency syndrome, 42 patients with mild stress urinary incontinence, and 18 with severe stress urinary incontinence. Transverse scanning over the midurethra was performed and cross-sectional images of the urethral and paraurethral structures were compared among the four groups, with P < 0.05 being considered statistically significant. The total cross-sectional area of the midurethra was significantly smaller in patients with stress urinary incontinence than in those without this disorder (86.7+/-29.9 versus 104+/-35.6 mm2, P = 0.005); this difference resulted from a significantly smaller peripheral striated muscle component in patients with stress urinary incontinence (42.8+/-20.7 versus 58.3+/-27.3 mm2, P = 0.001). The thickness of the urethropelvic ligaments was significantly thinner in patients with stress urinary incontinence than in those without (5.9+/-1.7 versus 8.9+/-2.1 mm, P < 0.001). The distribution of the peripheral striated muscle around the urethra was variable: complete surrounding the urethra was noted in 35.7% of the control women and in 48.6% of frequency-urgency patients, but only in 16.7% of patients with mild stress urinary incontinence and 5.3% of patients with severe disease. Bladder neck incompetence was seen in 42 patients with stress urinary incontinence but in none of the control women. The length of the pubourethral ligaments was similar in the four groups. Our finding showed that stress urinary patients had a smaller striated muscle component in the midurethra and thinner urethropelvic ligaments. These defects in the continence mechanisms might have great implications in the pathophysiology of stress urinary incontinence. Transrectal sonography of the urethra is a valuable investigative tool in assessing urethral and paraurethral conditions in patients with stress urinary incontinence before deciding treatment modality.     

Assessment of female urinary incontinence by introital sonography

By the use of a vaginal sector scanner, placed to the vaginal introitus (introital sonography), we studied the static and dynamic function of the urethrovesical region in patients with genuine stress incontinence and detrusor instability. Patients with genuine stress incontinence (n = 25) revealed either an increase of the retrovesical angle or the angle of inclination associated with a descent of the bladder neck during coughing. Opening of the bladder neck during cystometry, showing an increase of the detrusor pressure, was observed in patients with motor urge incontinence (n = 10). Application of the technique is recommended in patients with stress incontinence undergoing surgery for objective intraoperative assessment of successful reformation of the urethrovesical junction, irrespective of the surgical procedure. Compared with radiologic techniques, introital sonography has many advantages with no radiation exposure and with minimal inconvenience to the patient.     

超声评价女性压力性尿失禁患者尿道不同分段的移动度

目的 评价超声观察尿道不同分段的移动度对于诊断女性压力性尿失禁(SUI)的价值.方法 分别在静息状态和Valsalva最大位移时对45例SUI患者(病例组)和20名正常受试(对照组)进行经会阴超声扫查.将整段尿道分为6段,并以耻骨联合为参照建立直角坐标系,测量尿道各个分段在两种状态下的坐标值,计算各分段的移动度.结果 与对照组比较,病例组尿道不同分段移动度存在不同差异.病例组代表尿道中段的U-2,3,4三点的移动度分别为(2.63±0.62) 、(2.32±0.47)、(2.01±0.41)cm,对照组分别为(2.21±0.54)、(1.92±0.42)、(1.69±0.36)cm,差异有统计学意义(P＜0.05);病例组U-1,5,6三点移动度分别为(3.01±0.76)、(1.85±0.37)、(1.86±0.66)cm,对照组分别为(2.69±0.87)、(1.72±0.40)、(1.74±0.45)cm,两组差异无统计学意义(P＞0.05).结论 女性SUI与尿道移动度增加、特别是中段尿道移动度的增加有关;经会阴超声能够清晰再现盆底结构,观察尿道不同分段的移动度,有利于诊断SUI.     

Treatment options for women with stress urinary incontinence

About one-quarter million surgical procedures are performed each year in the United States for stress urinary incontinence. After outlining the presentation and diagnostic evaluation of stress urinary incontinence, this review concentrates specifically on the numerous conservative management strategies and minimally invasive surgical options for women with this common complaint. In the evaluation of nursing home residents with incontinence, the Minimum Data Set and Resident Assessment Protocol facilitate nonspecialist evaluation and management. In healthy adults, the therapeutic implications of the physical examination of the pelvic floor, assessing for the presence and strength of the voluntary contraction of the pelvic floor muscles, are detailed as the basis for all conservative management strategies. Reports on the effectiveness of pelvic floor muscle reeducation and pelvic floor electrical stimulation vary substantially, as do long-term results of surgical interventions. Surgical management is highly effective in the appropriate candidate. The current theory and practice of surgical treatment of stress urinary incontinence are outlined, with certain caveats regarding the lack of long-term follow-up for newer less invasive techniques.     

Home treatment for women with stress urinary incontinence

Urinary incontinence is an unpleasant, unwanted and distressing problem that is common among women in the UK. A recent study (Hunskarr et al, 2004) estimated that 10 million women in the UK suffer with urinary incontinence. Stress urinary incontinence (SUI) is the most common form, affecting four million women. The International Continence Society defines SUI as 'the complaint of involuntary leakage [of urine] on effort or exertion, or on sneezing or coughing' (Abrams et al, 2002).     

Nursing management of stress urinary incontinence in women

Although urinary incontinence is not a subject spoken about in general conversation, it is a cause of concern for many people. Stress urinary incontinence is common, being reported by 16.8% of women (Hunskaar et al, 2002). In the past, women with stress urinary incontinence were often dismissed as having an inevitable problem resulting from childbirth and the hormonal changes associated with ageing. They were often made to feel that they just had to put up with the problem--this is no longer the case. Conservative therapy is advocated as the primary intervention for those suffering with stress urinary incontinence and nurses are ideally placed to be a source of information and help. Furthermore, nurses can develop their skills in order to encompass therapies to become more specialist and effective. In 2000, the Department of Health (DoH) issued guidance on establishing integrated continence services (DoH, 2000). This becomes mandatory for older people from April 2004 (DoH, 2001a).     

超声联合盆底肌生物反馈技术评价压力性尿失禁产妇尿道高活动度

<正>我国成年女性中,压力性尿失禁(stressurinary incontinence,SUI)患病率高达18.9%^[1]。临床多通过病史、症状及体征诊断SUI,但对判断SUI病因及识别合并症存在一定困难^[2-3]。妊娠及分娩是导致神经、周围结缔组织和盆底肌肉损伤重要因素^[4]。盆底超声可从形态及功能两方面综合评估膀胱、尿道及周围病变,实时、动态显示膀胱颈、尿道运动轨迹,早期发现尿道高活动度型SUI;     

Recent developments in stress urinary incontinence in women

This article provides an overview of stress urinary incontinence (SUI) and current treatments. The role of the specialist nurse is also explored. It is recommended that conservative treatment is offered to all women with SUI.     

Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo.

OBJECTIVE: To determine whether introital sonography and magnetic resonance imaging (MRI) after TVT (tension-free vaginal tape) insertion can depict the polypropylene tape, and thus be used for patient follow-up. METHODS: The study comprised an experimental part, which investigated in-vitro visualization of the polypropylene tape in a model (phantom), and a clinical part, in which 20 women (mean age, 53.4 years) with clinically and urodynamically proven stress urinary incontinence without prolapse were investigated by introital ultrasound and MRI before and 13 months after the TVT procedure. RESULTS: In the phantom, the polypropylene tape was depicted with a low signal intensity by MRI and as a highly echogenic structure by ultrasound. In the clinical study, introital ultrasound in a mediosagittal orientation depicted the vaginal tape in all patients: it was located under either the midurethra (n = 16) or the lower urethra (n = 4), and in either the muscular coat of the urethra (n = 8) or in the urethrovaginal space (n = 12), the tape was either flat (n = 6) or curled up (n = 14), and there was no retropubic visualization of the tape. Overall, depiction by MRI was limited, and was poorer in comparison with ultrasound, especially when the tape had a sub- or paraurethral location. Retropubically, however, MRI identified the tape near the periosteum of the pubic bone (55% of cases), in the retropubic space (37.5% of cases), or near the bladder wall (7.5% of cases). CONCLUSION: Sonography is recommended for evaluation of the suburethral and paraurethral tape portions, while MRI is suitable for retropubic evaluation after the TVT procedure.     

女性压力性尿失禁患者尿道支持韧带损伤的MRI表现

目的：分析女性压力性尿失禁（SUI）患者的尿道支持韧带在MR上的异常表现,总结MR对其损伤性改变的诊断能力。资料与方法：分别选择女性SUI患者与健康成年人各20例进行盆底MR扫描,对比观察和分析耻骨尿道韧带、尿道周围韧带及尿道旁韧带的正常和异常形态学变化。结果：在健康成年女性中,尿道支持韧带表现为连续的线样低信号影,耻骨尿道韧带可通过矢状位结合横断位观察,尿道周围韧带及尿道旁韧带可通过横断位观察,在SUI患者中,尿道支持韧带均有不同程度受损,表现为韧带连续性中断或局部松弛变形。结论：MR检查可以有效判断患者尿道支持韧带损伤部位和类型。     

压力性尿失禁女性患者盆底三维超声观察

目的应用经会阴三维超声观察压力性尿失禁患者在静息、Valsalva和缩肛时肛提肌裂孔和耻骨内脏肌的变化。方法对照组35例,尿失禁组32例,应用经会阴三维超声技术,分别在静息、Valsalva和缩肛时测量肛提肌裂孔横径（N）、前后径（M）、耻骨内脏肌厚度（C）和肛提肌左右支的夹角（1）。结果静息时,尿失禁组与对照组M、N、C、γ比较,无统计学差异（P〉0．05）;Valsalva和缩肛时,尿失禁组C较对照组薄（P〈0．05）;缩肛时,尿失禁组M较对照组长,C较对照组薄（P〈0．05）。结论经会阴三维超声可用于评估耻骨内脏肌功能,压力性尿失禁患者其功能下降。     

Female stress urinary incontinence: office-based urethral bulking agent procedure

Urethral bulking agents have been used extensively to treat women with stress urinary incontinence due to intrinsic sphincter deficiency. This article presents the authors' experience with one of the currently approved urethral bulking agents, Macroplastique, in a urology office setting.     

Ultrasonic evaluation of urethrovesical junction in women with stress urinary incontinence

An ultrasonic evaluation of the bladder base and urethrovesical junction, at rest and during stress, using a transrectal probe, was performed on 24 continent and 67 incontinent patients. Forty-four of the incontinent patients had clinical and urodynamic diagnoses of stress urinary incontinence and 23 patients had detrusor instability incontinence. Thirty-eight of the 44 patients (86%) with urodynamically and urethroscopically proven genuine stress urinary incontinence and a weak urethral sphincter had a urethrovesical junction (UVJ) drop during stress of greater than or equal to 1 cm (mean 1.3 cm +/- 0.6 cm), as demonstrated on transrectal ultrasonic evaluation. All 23 patients with detrusor instability and 22 of the 24 continent (control) patients had UVJ drop on straining of less than 1 cm (mean 0.48 cm +/- 0.23 cm and 0.54 cm +/- 0.29 cm, respectively, p less than 0.05). The sensitivity of ultrasonic evaluation of women with stress urinary incontinence (when 1-cm drop of UVJ is considered as the upper boundary of normal) was 86% and the specificity was 91%. This ultrasound technique is quick, simple, and appears to be accurate. We believe this technique should be considered in the preoperative evaluation of women with stress urinary incontinence.     

认知行为干预对女性压力性尿失禁患者盆底肌训练依从性和治疗效果的影响

目的:探讨认知行为干预对轻中度女性压力性尿失禁患者盆底肌训练依从性和治疗效果的影响。方法:选择88例轻中度压力性尿失禁患者,按照抽签方法随机分为观察组45例和对照组43例,分别对两组患者入组前及入组后2周,1,2,3个月进行1 h尿垫试验和采用国际尿失禁咨询委员会尿失禁问卷表简表评估尿失禁次数和量,采用尿失禁生活质量问卷(QOL)评估对生活质量的影响。结果:入组1,2,3个月干预组患者依从性明显较对照组提高,疗效明显比对照组好,差异具有统计学意义(P0.05)。结论:对轻中度尿失禁患者进行认知行为干预能保证患者的依从性,且临床疗效明显。     

经会阴二维超声在女性压力性尿失禁中的临床应用

目的 探讨经会阴二维超声在女性压力性尿失禁(FSUI)的诊断、临床分型及病因鉴定中的临床应用价值。方法 对77例FSUI患者(病例组)和41名健康体检女性(对照组)行经会阴二维超声,观察静息和瓦氏动作后膀胱颈、膀胱后角及近端尿道的动态变化、静息时膀胱颈有无漏斗形成、是否合并膀胱膨出及子宫脱垂情况,并进行比较分析。结果 病例组静息和瓦氏动作后膀胱颈y轴位移(Δy)、静息时膀胱后角(α)、瓦氏动作后膀胱后角及近端尿道旋转度大于对照组(P均<0.05);病例组静息时膀胱颈漏斗形成率、合并膀胱膨出率及子宫脱垂率大于对照组(P<0.05);病例组静息至瓦氏动作后膀胱颈x轴位移略大于对照组,但差异无统计学意义(P>0.05)。结论 经会阴二维超声可实时动态显示盆底组织结构,可对FSUI的临床分型及病因鉴定提供丰富的影像学信息,在FSUI的诊断、治疗及预后判断方面均有具重要意义。     

超声评估女性膀胱脱垂与压力性尿失禁的相关性研究

摘要：目的 探讨女性膀胱脱垂的超声特点及其与压力尿失禁的相关性。方法 2016年4月至2018年4月在本院就诊的90例膀胱脱垂合并SUI的患者,设为脱垂+SUI组。同期来本院就诊的90例膀胱脱垂患者,设为脱垂组（无SUI）。同期来本院体检的女性患者95例,设为对照组（无泌尿系统疾病）。各组均经会阴进行盆底二维超声检查。比较各组超声参数,根据二维超声检测结果,进行膀胱脱垂的分型。比较不同分型膀胱脱垂患者的超声参数。结果 脱垂+SUI组、脱垂组的膀胱尿道后角（PUA）、膀胱颈下降值（BND）、膀胱后壁最低点下降值、尿道旋转角均明显高于对照组,差异均有统计学意义（P<0.01）。脱垂+SUI组的膀胱后壁最低点下降值、尿道旋转角均明显低于脱垂组,差异有统计学意义（P<0.01）。脱垂+SUI组以I、II型膀胱脱垂为主。I、II型膀胱脱垂患者的PUA均明显高于III型,膀胱后壁最低点下降值、尿道旋转角均明显低于III型,差异均有统计学意义（P<0.01）。结论 二维盆底超声能够对膀胱脱垂及其不同类型进行评估和分析。SUI患者的膀胱脱垂以膀胱尿道膨出为主,主要超声表现特点为膀胱尿道后角增大及膀胱颈漏斗的形成。     

经会阴超声对妊娠晚期压力性尿失禁患者盆底结构的观察

目的探讨经会阴超声对妊娠晚期压力性尿失禁(SUI)的诊断价值。方法妊娠晚期女性114例,其中60例无SUI为Ⅰ组,54例患有SUI为Ⅱ组;另63例体检健康未育女性为对照组。经会阴超声观察静息状态及张力状态下盆底结构,测量膀胱颈在X轴、Y轴的移动度(ΔDx、ΔDy),膀胱旋转角度(Δβ),膀胱颈活动度(ΔD)。结果Ⅰ组、Ⅱ组和对照组在膀胱颈张力期较静息期均向后下移位。ΔD、Δβ在Ⅰ组、Ⅱ组、对照组的组间递增,差异均有统计学意义(P0.05);Ⅰ组和Ⅱ组ΔDy均小于对照组,Ⅱ组ΔDx大于对照组(均P0.05)。结论患有SUI妊娠晚期女性膀胱尿道周围支持结构有明显改变,经会阴超声对妊娠晚期女性SUI的诊断有重要临床价值。