盆底生物反馈电刺激治疗女性轻中度压力性尿失禁的疗效观察简

目的探讨盆底生物反馈电刺激治疗对女性轻、中度压力性尿失禁的临床疗效。方法选择2012年3月～2013年5月大连市妇幼保健院诊治的120例轻、中度压力性尿失禁患者,年龄33-77岁。将患者分2组,每组60例。60例接受盆底生物反馈电刺激治疗的患者作为治疗组.60例仅作常规盆底肌肉锻炼的患者作为对照组。记录治疗组患者治疗前后盆底肌的肌电变化客观指标。进行对比分析。结果治疗组症状缓解明显,痊愈率为48.3％,显效率为46.7％,无效率为5.0％,总有效率95.0％。对照组治疗效果较差.痊愈率为10.0％,显效率为26.7％,无效率为63-3％,总有效率36.7％;治疗组有效率明显高于对照组,差异有统计学意义（P〈0.05）。治疗组患者接受治疗后,盆底肌2s快速收缩表面肌电图（sEMG）最大值、盆底肌持续10s收缩sEMG平均值、盆底肌肉60s耐受收缩sEMG平均值均较治疗前有明显提高,差异有统计学意义（P〈0.05）。结论盆底生物反馈电刺激治疗是安全、有效的治疗女性轻、中度压力性尿失禁的方法。     

盆底磁刺激治疗女性压力性尿失禁近期疗效初探

目的探讨盆底磁刺激治疗女性压力性尿失禁的短期临床效果。方法20例压力性尿失禁患者，平均年龄为（52．5±11．0）岁．平均产次（1．4±0．6）次：11例（56％）处于绝经期。接受Neocontrol 盆底磁刺激治疗8周，根据治疗前后患者主观和客观临床参数评分进行疗效评价，并进行治疗前后生活质量评分和膀胱充盈试验，治疗结束后随访3个月,随诊率100％。结果治疗结束后75％患者不再漏尿，15％患者症状得到改善。1h尿垫试验结果平均溢尿量减少7．6g,3d溢尿次数平均减少5．1次。16例患者治疗前后行膀胱灌注试验,治疗后初始排尿欲膀胱容量和最大膀胱容量较治疗前增大,差异有统计学意义（P〈0．05）。所有患者生活质量评分显著提高（P〈0．05）。治疗中未见任何副作用。治疗后随诊3个月，治愈患者中60％症状复发。结论盆底磁刺激是治疗压力性尿失禁的安全、有效、简便、无痛的方法，但疗效持续时间较短。     

Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies

The aim of this study was to explore the anatomical variations of the nerve to the levator ani (LA) and to relate these findings to LA dysfunction. One hundred fixed human female cadavers were dissected using transabdominal, gluteal, and perineal approaches, resulting in two hundred dissections of the sacral plexus. The pudendal nerve and the sacral nerve roots were traced from their origin at the sacral foramina to their termination. All nerves contributing to the innervation of the LA were considered to be the nerve to the LA. Based on the spinal nerve components, the nerve to the LA was classified into the following categories: 50% (n = 100) originated from S4 and S5 (type I); 19% (n = 38) originated from S5 (type II); 16% (n = 32) originated from S4 (type III); 11% (n = 22) originated from S3 and S4 (type IV); 4% (n = 8) originated from S3, S4, and S5 (type V). Two patterns of nerve termination were observed. In 42% of specimens, the nerve to the LA penetrated the coccygeus muscle and assumed an external position along the inferior surface of the LA muscle. In the remaining 58% of specimens, the nerve crossed the superior surface of the coccygeus muscle and continued along the superior surface of the iliococcygeus muscle. Damage to the nerve to LA has been associated with various pathologies. In order to minimize injuries during surgical procedures, a thorough understanding of the course and variations of the nerve to the LA is extremely important. Clin. Anat. 29:516–523, 2016. © 2015 Wiley Periodicals, Inc.     

女性盆底功能障碍性疾病治疗的回顾性分析

目的探讨女性盆底功能障碍性疾病的治疗方法及临床疗效。方法回顾我院56例女性盆底功能障碍性疾病的临床资料,对其治疗方法、临床疗效进行分析。结果 56例患者治疗后效果良好,非手术治疗12例,治疗后随访复发3例,经手术治疗44例,复发1例。结论选用合适的治疗方式,联合治疗能有效地治疗女性盆底功能障碍性疾病。     

Twisted orientation of the muscle bundles in the levator ani functional parts in women: Implications for pelvic floor support mechanism

This study presents a comprehensive investigation of the anatomical features of the levator ani muscle. The levator ani is a critical component of the pelvic floor; however, its intricate anatomy and functionality are poorly understood. Understanding the precise anatomy of the levator ani is crucial for the accurate diagnosis and effective treatment of pelvic floor disorders. Previous studies have been limited by the lack of comprehensive three-dimensional analyses; to overcome this limitation, we analysed the levator ani muscle using a novel 3D digitised muscle-mapping approach based on layer-by-layer dissection. From this examination, we determined that the levator ani consists of overlapping muscle bundles with varying orientations, particularly in the anteroinferior portion. Our findings revealed distinct muscle bundles directly attached to the rectum (LA-re) and twisted muscle slings surrounding the anterior (LA-a) and posterior (LA-p) aspects of the rectum, which are considered functional parts of the levator ani. These results suggest that these specific muscle bundles of the levator ani are primarily responsible for functional performance. The levator ani plays a crucial role in rectal elevation, lifting the centre of the perineum and narrowing the levator hiatus. The comprehensive anatomical information provided by our study will enhance diagnosis accuracy and facilitate the development of targeted treatment strategies for pelvic floor disorders in clinical practice.     

骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗盆腔器官脱垂

目的探讨骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗中、重度盆腔器官脱垂的临床应用价值。方法回顾分析我院应用骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗32例中、重度盆腔器官脱垂患者的临床资料。结果 32例盆腔器官脱垂患者均以中盆腔、前盆腔缺陷为主,子宫脱垂程度均为Ⅲ度以上,都合并不同程度的阴道前后壁脱垂。行经阴道全子宫切除术+阴道前后壁修补术+骶棘韧带悬吊术+骶韧带耻骨阴道肌筋膜交叉缝合术(有压力性尿失禁患者加行尿道后韧带折叠术)。手术时间60~120 min,失血量100~300 m L,无严重并发症发生。32例术后无1例复发。结论骶韧带耻骨阴道肌筋膜交叉缝合术可显著减少骶棘韧带悬吊术治疗盆腔器官脱垂术后前盆腔缺陷复发概率,可显著加固前盆腔,且简单、安全、有效,值得在临床推广运用。     

A state-of-the-art review on the evolution of urinary sphincter devices for the treatment of post-prostatectomy urinary incontinence: Past,present and future innovations

An artificial urinary sphincter (AUS) is the only mechanical device that closely simulates the function of a biological urinary sphincter. Over the past four decades, advances in mechanical design, applications of new technology and lessons learned from clinical experience have made AMS 800 device the standard of care in post-prostatectomy urinary incontinence. While the current AMS 800 device provides an effective, safe and durable option, it is not without its limitations and complications. Newer and innovative AUS-like devices are designed to rectify some of AMS 800 device problems, but, like any mechanical device, they too have their own shortcomings. Emerging novel therapies such as nanotechnology-driven device and stem cell therapy are attractive, but are not commercially available or have no proven long-term outcome. The following article provides a critical review on the past, present and future innovations in designing the ideal urinary sphincter to treat post-prostatectomy urinary incontinence.     

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.     

动态MRI在评估女性压力性尿失禁患者膀胱尿道解剖及功能学中的意义

目的通过盆底动态MRI结合尿动力学检查评估女性压力性尿失禁(stress urinary incontinence,SUI)患者膀胱尿道解剖学异常与功能学改变的相关性。方法回顾性分析本院2011年2月至2013年11月收治的60例女性压力性尿失禁(SUI)患者的临床资料,盆底动态MRI正中矢状面上测量H线长度、M线长度、尿道前倾角以及膀胱、子宫、肛直肠连接部越过耻尾线(pubococcygeal line,PCL)的距离,记录尿动力学参数,Pearson's相关性分析统计分别统计H线、M线长度与尿道前倾角的相关性,H线、M线长度与膀胱颈、子宫、肛直肠连接部越过耻尾线(PCL)的距离的相关性,H线、M线长度与尿动力学参数的相关性。结果 H线、M线长度与尿道前倾角呈正相关,H线、M线长度分别与膀胱颈、子宫、肛直肠连接部越过耻尾线(PCL)的距离呈正相关,H线、M线长度分别与功能性尿道长度、最大尿道闭合压、腹压漏尿点压(VLPP)、逼尿肌开启压呈负相关。结论盆底动态MRI结合尿动力学检查能够对女性压力性尿失禁(SUI)患者膀胱尿道的形态及功能学改变进行较全面的评估。     

An effective and acceptable treatment alternative for chronic thumb- and finger-sucking

Evaluated treatment for thumb-sucking in a randomized trial. Study included 22 children, ages 4-11, who displayed chronic thumb-sucking. Treatment included aversive taste and a reward system. Significant results were obtained at posttest, with 12 cessations at 3-month follow-up and 20 at 1 year. Participating parents, pediatricians, and pediatric psychologists validated treatment acceptability. Results support the treatment as an alternative to common medical and dental advice about thumb-sucking. Directions for future research are discussed.     

Microbial risk factors for treatment failure of pivmecillinam in community-acquired urinary tract infections caused by ESBL-producing Escherichia coli

The aim of this study was to identify microbial risk factors for treatment failure of pivmecillinam in community-acquired urinary tract infections (ca-UTIs) caused by ESBL-producing Escherichia coli. Eighty-nine ESBL-producing E. coli isolated from women suffering from ca-UTIs were included. The susceptibilities to mecillinam were determined using MIC gradient strip. Whole genome sequencing was performed on a MiSeq platform, and genome assembly was performed using SPAdes v3.11.0. Neither mecillinam MICs nor ESBL genotypes were associated with treatment outcome of patients treated with pivmecillinam. Specific STs, however, showed significant differences in treatment outcome. Patients infected with ST131 were more likely to experience treatment failure compared to patients infected with non-ST131 (p 0.02) when adjusted for pivmecillinam dose, mecillinam MIC and severity of infection. Patients infected with ST69 were more often successfully treated compared to patients infected with non-ST69 (p 0.04). Patients infected with bla_CTX-M-15 ST131 strains were more likely to experience treatment failure than those infected with non-bla_CTX-M-15 ST131 strains (p 0.02). The results suggest that specific STs are associated with the clinical efficacy of pivmecillinam. Further studies with a larger number of strains, including a larger number of mecillinam resistant strains, are needed to confirm these results.     

Anatomical basis for functional treatment of dorsolateral dislocation of the proximal interphalangeal joint

Dorsolateral dislocation of the proximal interphalangeal (PIP) joint is a common injury to the hand. Closed reduction of the dislocation anatomically realigns the avulsed ligaments; thus patients may be managed non-operatively. Standard treatment involves placement of a dorsal splint to prevent hyperextension and lateral stresses. This allows early active motion of the PIP joint while preventing a flexion contracture. In this fresh cadaver study, the PIP joint in 24 fingers was dorsolaterally dislocated. Four digits had to be excluded from the investigation due to a fracture dislocation with a bony fragment of >40% of the articular surface of the middle phalanx. After closed reduction, seven digits were further studied using the cryosection technique described by Kathrein et al. (1996, Clin. Anat. 9:227-231) to demonstrate the position of the avulsed palmar plate. In another 13 joints, the torn ligaments were examined by gross dissection. In 10 degrees of finger flexion, the avulsed palmar plate lay at its previous attachment to the base of the middle phalanx. The collateral ligament, ruptured at its attachment to the side of the head of the proximal phalanx, returned to its original position and was not interposed in the joint. The split between the collateral ligament and the accessory collateral ligament was also closed. Our data suggest that the ligamentous structures of the PIP joint, namely the palmar plate and collateral ligaments, typically return to their anatomic positions upon simple closed reduction of dorsolateral dislocations in fresh cadavers.     

An ultra-miniinvasive treatment for stress urinary incontinence in complicated older patients

Objective

To evaluate use of bulking agents (polydimethylsiloxane) as an alternative treatment of female stress urinary incontinence (SUI) in older patients.

Study design

Prospective cohort study.

Main outcome measures

Women with age >75 years old, affected by stress urinary incontinence, presenting to our institution between January 2005 and January 2008 were considered for eligibility in this prospective study. All patients were submitted to transurethral implantation using Macroplastique Implantation System (MIS) (Uroplasty, Minneapolis, Minnesota). Cure of SUI was defined as the resolution of SUI symptoms. Objective cure rate was assessed by urogynecological physical examination and urodynamic assessment performed at 6 and 12 months after surgery respectively. Subjective cure rate was assessed during the interview of the 12th month with a visual analogue scale (VAS) for quantification of SUI severity and a standardized question about the repeatability of the procedure.

Results

A total of 27 consecutive patients were enrolled in this study. After 12 months of surgery the objective cure rate was 44% (12 of 27 patients), the improvement rate was 33% (9 of 27) and the failure rate was 22% (6 of 27). The overall success rate was 77% (12 patients cured and 9 improved). 23 (85%) patients would like to repeat this surgical procedure if necessary.

Conclusion

Transurethral implantation of bulking agents should be considered as alternative treatment of SUI in complicated older patients.     

部分无管化与传统经皮肾镜取石术治疗上尿路结石的临床疗效对比

目的对比部分无管化经皮肾镜碎石取石术(不留置肾造瘘但留置双J管)与传统经皮肾镜碎石取石术(既留置肾造瘘管也留置双J管)治疗上尿路结石的临床疗效,评价部分无管化经皮肾镜碎石取石术的临床可行性及应用价值。方法选择2013年5月至2014年5月入住我院需行经皮肾镜碎石取石术治疗且符合入选标准的上尿路结石患者206例,按手术次序的奇偶分为观察组(部分无管化经皮肾镜碎石取石术组)与对照组(传统经皮肾镜碎石取石术组),观察比较2组患者手术时间、结石清除率、疼痛评分(VAS)、术后镇痛药需求量、术后血红蛋白下降值、术后输血、术后大出血、术后发热、漏尿时间、术后住院天数、住院费用、术后恢复正常生活工作时间等指标的区别。结果 206例患者均顺利完成手术,2组手术时间、结石清除率、术后血红蛋白下降值、术后输血、术后大出血、术后发热病例比较差异均无统计学意义(P0.05);观察组术后疼痛评分(VAS)、术后镇痛药用量、漏尿时间、术后住院时间、住院费用、术后恢复正常生活工作时间均显著低于对照组(P0.05)。结论部分无管化经皮肾镜碎石取石术与传统经皮肾镜碎石取石术相比,在减轻患者术后疼痛、减少漏尿时间、缩短患者术后住院时间、降低住院费用及加快患者术后恢复正常生活工作上具有明显的优势,具有很大的临床应用价值,值得推广应用。     

Is it time to reconsider initial antibiotic treatment strategies for severe urinary tract infections in Europe?

Until recently, most reported cases of bacteraemia caused by multidrug-resistant strains of Enterobacteriacae producing an extended-spectrum beta-lactamase (ESBL) in Europe have been nosocomial in origin. However, increasing numbers of reports of community-acquired bacteraemia and urinary tract infection caused by ESBL-producing microorganisms suggest that the geographical origin of patients should be taken into account as a risk-factor for possible ESBL production. Early identification of patients at high-risk of infection with ESBL-producing microorganisms, based on their geographical origin and travel history, should help to optimise initial antibiotic treatment strategies for severe urinary tract infections in Europe.     

Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): Design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care

Pelvic floor muscle training (PFMT) and pessaries are commonly used in the conservative treatment of pelvic organ prolapse (POP). Because there is a lack of evidence regarding the optimal choice between these two interventions, we designed the “Pelvic Organ prolapse in primary care: effects of Pelvic floor muscle training and Pessary treatment Study” (POPPS). POPPS consists of two parallel open label randomized controlled trials performed in primary care, in women aged ≥55 years, recruited through a postal questionnaire. In POPPS trial 1, women with mild POP receive either PFMT or watchful waiting. In POPPS trial 2, women with advanced POP receive either PFMT or pessary treatment. Patient recruitment started in 2009 and was finished in December 2012. Primary outcome of both POPPS trials is improvement in POP-related symptoms. Secondary outcomes are quality of life, sexual function, POP-Q stage, pelvic floor muscle function, post-void residual volume, patients’ perception of improvement, and costs. All outcomes are measured 3, 12, and 24 months after the start of treatment. Cost-effectiveness will be calculated based on societal costs, using the PFDI-20 and the EQ-5D as outcomes. In this paper the POPPS design, the encountered challenges and our solutions, and participant baseline characteristics are presented. For both trials the target numbers of patients in each treatment group are achieved, giving this study sufficient power to lead to promising results.     

用于功能性胃肠疾病治疗的植入式电刺激系统及动物实验研究

目的研究可用于功能性胃肠疾病治疗的植入式电刺激系统,通过动物实验研究,探讨不同刺激参数对胃肠道收缩活动的作用效果,为治疗用刺激参数的优化提供初步依据。方法系统由便携式体外控制器和植入式体内刺激器组成,体内外通信采用无线模式。刺激脉冲参数及指令由体外控制器设定并发送至体内刺激器,胃肠道收缩活动由体内刺激器集成的压力检测模块采集并发送至体外以供分析。通过电刺激猪盲肠实验,分析不同刺激参数下盲肠压力的变化,以评价刺激参数对盲肠收缩活动的作用效果。结果系统样机工作正常,输出刺激脉冲信号精确,压力信息记录准确。动物实验表明,增加刺激脉冲宽度使盲肠收缩活动的幅度增大,增加刺激脉冲频率使盲肠收缩活动的潜伏期缩短,增加刺激脉冲幅度同时缩短盲肠收缩活动的潜伏期并增大收缩幅度。结论该植入式电刺激系统参数设定范围大,输出脉冲信号精确并具备压力检测功能,便于进行功能性胃肠疾病治疗刺激参数的筛选和验证。动物实验初步验证了不同刺激参数对盲肠收缩活动的作用效果。     

An impending crisis in the provision of histopathology expertise for mouse functional genomics

The generation of new mouse models of human disease is accelerating rapidly, due to the completion of whole‐genome sequencing efforts and technological advances in the manipulation of the mouse genome. We sought to investigate manpower issues in the provision of histopathology expertise for mouse functional genomics and compared this to the perceived demand from principal investigators (PIs). Through the European Commission (EC)‐funded PRIME pathology training initiative, two questionnaires were devised to collect information from pathologists and EC‐funded PIs on the current provision of mouse histopathology expertise in Europe and the demands for this service. We find that pathological analysis is being performed almost exclusively by professionally qualified pathologists, generally employed in clinical diagnostic posts, where the work is undertaken as collaboration outside of their contractual commitments but without previous training in veterinary or comparative pathology. The results indicate that there is a lack of both trainees and provision of specialist training in this field. Unsurprisingly, the availability of diagnostic expertise and advice falls far short of the number of genetically engineered mice (GEM) being generated for analysis. We analyse these results with reference to previous studies and discuss solutions for the future recruitment, training and funding for pathologists in mouse functional genomics in Europe. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.