盆底超声及相关检查技术诊断产后压力性尿失禁

目的 研究智能盆底超声参数、盆底表面肌电(sEMG)及盆底肌纤维肌力对产后压力性尿失禁(SUI)的诊断与病情严重程度的关系.方法 选取196例产妇,根据尿失禁分为SUI组(56例)和非SUI组(140例).采用Pearson法分析智能盆底超声参数、sEMG及盆底肌纤维肌力与国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-...     

针灸结合盆底肌训练治疗产后压力性尿失禁

目的观察针灸结合盆底肌训练治疗产后压力性尿失禁的疗效。方法 100例符合筛选条件、自然分娩的产妇分成对照组50例和治疗组50例。对照组单纯采用盆底肌训练,治疗组采用针灸(毫针针刺、艾灸)和盆底肌训练综合治疗。于治疗4周后进行疗效评定。结果治疗组总有效率84%,对照组总有效率56%(χ2=10.54,P<0.01)。结论针灸治疗可提高盆底肌训练对产后压力性尿失禁的疗效。     

盆底肌锻炼治疗压力性尿失禁效果的系统评价

目的 检测盆底肌锻炼对压力性尿失禁的治疗效果。方法 经系统文献回顾，筛选出4个随机临床试验．进行Meta-分析，对判断指标进行评价。结果 盆底肌锻炼对“治愈”、“有效”、“无效率”、自觉尿失禁症状和排尿紧迫感等判断指标的作用，有显著意义；但对盆底肌快速收缩肌力和最大尿道闭合压力的作用，无显著意义。结论 盆底肌锻炼对压力性尿失禁治疗有效。     

盆底肌锻炼对前列腺切除术后暂时性尿失禁的影响

目的:探讨盆底肌锻炼用于防治前列腺切除术后暂时性尿失禁的效果。方法:将72例需行前列腺手术的患者随机分为试验组和对照组,每组36例。试验组患者于术前、术后拔管前和拔管后计划性地进行盆底肌锻炼;对照组患者仅在术后发生尿失禁时进行盆底肌锻炼。比较两组术后暂时性尿失禁的发生率、严重程度和持续时间。结果:试验组术后拔除尿管后5d、10 d和15 d的尿失禁发生率分别为22.2%、16.7%和13.9%,对照组则相应为52.8%、33.3%和27.8%,两组差异有统计学意义(P0.05)。试验组中Ⅰ度尿失禁6例,Ⅱ度2例,Ⅲ度3例;对照组中Ⅰ度9例,Ⅱ度8例,Ⅲ度2例。对照组中Ⅱ度尿失禁发生率明显高于试验组(P0.05)。结论:盆底肌锻炼有助于降低前列腺切除术后暂时性尿失禁的发生率和严重程度,并能缩短尿失禁的持续时间。     

产后压力性尿失禁妇女盆底肌训练知信行现状及影响因素分析

目的:调查产后压力性尿失禁（SUI）患者盆底肌训练知信行情况。方法:便利选取2018年1月—2019年1月北京某妇产医院产后12周在盆底门诊就诊患者213例,采用产褥期妇女盆底肌功能锻炼知信行及需求问卷进行调查,分析患者盆底肌功能锻炼知信行的影响因素。结果:213例SUI患者盆底肌训练知信行总体标准分为（75.70±1...     

阴道内电刺激治疗产后压力性尿失禁的临床效果

目的观察阴道内电刺激治疗产后压力性尿失禁(SUI)的近期临床效果。方法产后42 d SUI产妇64例分为观察组(n=28)和对照组(n=36),两组均给予产后健康训练指导,观察组给予阴道内电刺激治疗12周。分别于产后6个月及12个月通过标准评分问卷、尿垫试验、盆底肌张力强度评分和治愈率观察效果。结果观察组各时间点各项指标均优于对照组(P<0.05)。结论阴道内电刺激可以有效治疗女性产后SUI。     

Stress Urinary Incontinence: A Review of Treatment Options

Stress urinary incontinence occurs when the support structures of the pelvic floor and the urinary system are stretched, damaged, or defective. This condition is common in women of all ages, and billions of dollars are spent each year to correct the condition and improve quality of life. This article reviews three current treatments for stress urinary incontinence: the Burch colposuspension procedure, urethral slings, and radiofrequency treatments. In one study, researchers reported that patient satisfaction rates were higher for the Burch procedure than for urethral sling procedures. Other researchers found that urethral sling procedures had high rates of success but that adverse events were more common. Adverse events for both types of procedures include voiding difficulties, postoperative urge incontinence, and urinary tract infections. Radiofrequency interventions can improve the quality of life for many patients and can provide a short-term intervention for many patients who later may require a more-invasive surgical procedure.     

围绝经期妇女压力性尿失禁的康复治疗分析

目的探讨围绝经期妇女压力性尿失禁的康复治疗方法。方法选取60例围绝经期压力性尿失禁妇女进行治疗,随机分为A组、B组和C组,每组20例。A组给予盆底锻炼,即Kegel训练;B组联合雌激素局部治疗;C组联合低频电刺激联合生物反馈治疗。结果尿失禁量与Kupperman评分呈正相关(r=0.752,P<0.01)。与治疗前比较,治疗1个月、3个月后Kupperman评分A组、B组、C组均明显降低(P<0.01);治疗1个月后,A组与B组比较差异无统计学意义;C组Kupperman评分明显降低(P<0.01),治疗3个月后进一步降低(P<0.01)。与治疗前比较,治疗1个月、3个月后尿失禁量A组、B组、C组均明显降低(P<0.01);A、B两组比较,尿失禁量治疗1个月、3个月后差异无统计学意义(P>0.05);C组与A、B两组比较,治疗1个月,3个月后尿失禁量明显降低(P<0.01)。结论盆底锻炼、低频电刺激联合生物反馈疗法可以明显减轻围绝经期妇女压力性尿失禁的症状。     

瑜伽训练在产后早期尿失禁治疗中的应用研究

目的:探讨瑜伽训练在产后尿失禁治疗中的应用价值。方法:选取2018年10~12月产后6周常规复查时明确诊断为产后尿失禁的90例产妇作为研究对象,随机分为Kegel组和Kegel+Yoga组,每组45例。Kegel组接受Kegel盆底肌训练,Kegel+Yoga组接受Kegel盆底肌训练联合瑜伽训练。参照Oxford盆底肌力评估法阴道指诊检测两组产妇干预前后盆底肌力变化情况,通过Bristol女性下尿路症状问卷调查两组产妇干预前后泌尿症状评分和生活质量2个维度评分的变化情况,并评估两组1个疗程后的临床疗效。结果:干预前,两组产妇的盆底肌力、Bristol下尿路症状问卷中泌尿症状评分和生活质量评分相比较,差异均无统计学意义,P>0.05;干预后,两组产妇的盆底肌力、Bristol下尿路症状问卷中泌尿症状评分和生活质量评分均较同组干预前显著改善,差异均有统计学意义,P<0.05;Kegel+Yoga组的上述指标和临床疗效均优于Kegel组,差异均有统计学意义,P<0.05。结论:产后早期瑜伽训练可以增强产妇盆底肌力,改善其尿失禁症状,提高生活质量。     

成年女性绝经前后发生的压力性尿失禁尿动力学比较

目的探讨在绝经前后发生压力性尿失禁的成年女性患者的不同尿动力学特点。方法对140例经临床确诊的成年女性压力性尿失禁患者(未绝经组71例、绝经组69例)行充盈性膀胱压力测定(FCM)、腹压漏尿点压测定(ALPP)以及尿道压力图测定,比较绝经前后的尿动力学参数和特点。结果未绝经组和绝经组ALPP值分别为(80±28)cmH2O和(64±27)cmH2O(P<0.01);未绝经组有15例(21.2%)ALPP<60cmH2O,而绝经组为26例(37.7%)(P<0.05);未绝经组有21例ALPP>90cmH2O,绝经组为8例(P<0.05)。未绝经组的最大尿道压(MUP)、最大尿道关闭压(MUCP)、控制面积(CA)与绝经组相比有显著性差异(P<0.05);而两组间的功能尿道长度(FUL)、控制带长(CZL)无显著性差异(P>0.05)。未绝经组和绝经组分别有5例(7%)和19例(27.5%)合并不稳定膀胱,两者有非常显著性差异(P<0.01)。结论绝经前后发生的女性真性压力性尿失禁有不同的尿动力学特点,在发生机制上可能存在差异。     

基于依从性曲线的阶段性护理干预在压力性尿失禁患者盆底功能康复训练中的应用

目的:探讨基于依从性曲线的阶段性护理干预在压力性尿失禁患者盆底功能康复训练中的应用效果。方法:采用便利抽样法,选取2019年1月—2020年6月在浙江中医药大学附属第二医院泌尿外科接受治疗的70例压力性尿失禁患者为研究对象,采用随机数字表法随机分为对照组和干预组,各35例。对照组采用常规护理,干预组患者在此基础上实施基...     

感应电疗法联合盆底肌训练治疗女性压力性尿失禁

目的 研究感应电疗法联合盆底肌训练治疗压力性尿失禁(sUI)的疗效.方法 对轻度、中度SUI患者各40例进行感应电治疗联合盆底肌训练,共16周.于治疗前后用国际尿失禁咨询委员会问卷简表(ICIQ-SF)以及1h尿垫试验进行评估.结果 治疗后,两组患者的ICIQ-SF评分均明显低于治疗前(P＜0.01);轻度组与中度组有效率分别为100％和72.5％.结论 感应电联合盆底肌训练可有效治疗女性SUI.     

Improving Care for Women With Urinary Incontinence in Primary Care

Urinary incontinence (UI) is highly prevalent in primary care, disproportionately impacts women, and is associated with poor quality of life related to significant psychological, physical, social, and financial burdens. UI places significant economic burden on the United States health care system. Cost-effective, first-line UI treatments improve continence and can be successfully offered in primary care. Unfortunately, UI is largely untreated, in part because health care providers fail to inquire about involuntary urine leakage and are uncomfortable with UI diagnosis and treatment. The aim of this article is to familiarize clinicians with UI risk factors and effective nonpharmacologic management strategies for primary care.     

Pelvic floor muscle activity in different sitting postures in continent and incontinent women

Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women.

Objective

To determine whether resting activity of the pelvic floor muscles (PFMs) and abdominal muscles varied in different sitting postures in parous women with and without stress urinary incontinence (SUI).

Design

PFM and abdominal muscle activity was recorded in 3 sitting postures: slump supported, upright unsupported, and very tall unsupported. Spinal curves were measured in slump supported and upright unsupported.

Setting

A research laboratory.

Participants

Women (N=17) with a history of vaginal delivery, 8 who were symptomatic of SUI and 9 who were asymptomatic.

Interventions

Not applicable.

Main Outcome Measures

Electromyographic activity of (1) the resting PFM recorded per vaginam with surface electrodes and (2) superficial abdominal muscles using surface electrodes. Changes in spinal curves were measured with a flexible ruler.

Results

Electromyographic activity of the PFM increased significantly from slump supported to upright unsupported postures in both groups (P<.001) but with lower levels of activity in women with SUI (P<.05). PFM activity increased further in very tall unsupported sitting in comparison with slump supported sitting (P<.001). Obliquus internus abdominis electromyographic activity was greater in upright unsupported than in slump supported sitting (P<.05), and electromyographic activity of other abdominal muscles was greater in very tall unsupported than slump supported. Women with SUI had a trend for greater activity in the abdominal muscles in upright unsupported than asymptomatic women. Asymptomatic women had a greater depth of lumbar lordosis in upright unsupported sitting than women with SUI (P=.04).

Conclusions

More upright sitting postures recruit greater PFM resting activity irrespective of continence status. Further investigation should consider the effect of sitting posture in rehabilitation.     

女性盆底肌锻炼的超声尿动力学实时观察

目的：应用超声尿动力学对女性压力性尿失禁盆底肌锻炼进行监测。方法：对30例压力性尿失禁患者盆底肌收缩与松弛动作进行观察，对照组为20例正常妇女。比较两组下尿路形态与盆底功能参数的差异。结果：盆底肌收缩较之松驰时，膀胱尿道连接部向前向上运动，尿道轴向上向前旋转，尿道最大关闭压、阴道压明显提高。病例组盆底肌收缩力度明显低于正常组。结论：超声尿动力学方法可以实时反映盆底肌运动时下尿路的解剖与盆底功能的改变，有利于对压力性尿失禁盆底肌的锻炼进行监测。     

盆底超声检测产后压力性尿失禁患者肛提肌损伤的回顾性分析

目的 通过盆底三维超声检查探索女性分娩后压力性尿失禁与肛提肌损伤的相关性 方法 选取符合纳入排出标准的产后压力性尿失禁患者、产后单纯前盆腔器官脱垂（anterior-pelvic organ prolapsed, POP）及产后盆底正常女性患者,采用盆底三维超声联合TUI技术检查测量静息状态下及Valsalva动作后三组患者肛提肌裂孔的前后径、横径及肛提肌裂孔面积,观察肛提肌裂孔及周边肌肉形态,并对各项指标进行统计学分析 结果 产后压力性尿失禁患者在静息状态下肛提肌裂孔前后径、横径相较于两组对照差异不明显,但valsalva动作后尤其是前后径差异明显变大;压力性尿失禁患者无论在静息状态和valsalva动作后,肛提肌裂孔面积相较其他两组都有明显的变大。应用TUI观察,压力性尿失禁患者发生肛提肌撕裂的比例相较其他两组增加 结论 肛提肌损伤、肛提肌裂孔面积的改变与压力性尿失禁的发生有明确的相关性     

生物反馈联合盆底肌锻炼治疗女性压力性尿失禁的疗效评价

目的 探讨生物反馈联合盆底肌锻炼治疗不同程度女性压力性尿失禁的近期疗效及盆底肌表面肌电检测的意义.方法 选取69例女性压力性尿失禁患者,依据临床症状分为轻度(26例)、中度(24例)和重度(19例)3组,进行12周的生物反馈联合盆底肌功能锻炼治疗,在治疗前、后分别记录排尿日记,填写国际尿失禁咨询委员会问卷简表(ICI-...