磁共振成像在压力性尿失禁诊断中的应用价值

目的:探讨磁共振成像(MRI)在压力性尿失禁(SUI)诊断中的应用价值。方法:对28例有典型临床表现并经尿动力检查确诊为SUI的患者,分别在自然和应力状态下行MRI,显示不同状态下膀胱尿道的位置及形态改变,测量两种状态时膀胱尿道连接点至耻尾线的垂直距离及距离差(即下移度)。并与18例健康对照者进行比较。结果:SUI组28例应力状态下膀胱尿道连接点明显下移,其中24例下移至耻尾线以下,下移距离(10.32±1.92)mm;18例正常对照者下移距离为(5.3±1.36)mm,与SUI组比较P<0.01,且膀胱尿道连接点均位于耻尾线以上。SUI组3例可见后尿道呈漏斗状开放;对照组后尿道形态均正常。完整地显示全尿道两组总共仅15例。结论:MRI可以直接表现解剖型SUI的尿道活动及其程度,显示膀胱颈后尿道的形态,从而间接判断Ⅲ型或Ⅱ/Ⅲ混合型SUI,同时操作简便,影像清晰,直观全面,并具非侵入性,但完整地显示全尿道有待于进一步探索。     

经会阴四维超声在女性压力性尿失禁诊断中的初步应用

目的探讨经会阴四维超声在女性压力性尿失禁（SUI）患者中的应用价值。方法应用经会阴四维超声技术,观察22例女性压力性尿失禁患者在静息和Valsalva动作（屏气并向下用力至最大腹压）两种状态下四维超声图像的变化,并分析平静呼吸状态下的尿道长度、膀胱逼尿肌厚度（DWT）;最大Valsalva动作后的膀胱颈移动度（BND）、尿道内口漏斗有无形成等指标。以26例正常女性作为对照。结果静息时,SUI组与对照组尿道长度及DWT比较,无统计学差异（P〉0．05）;最大Valsalva动作时,SUI组的膀胱颈移动度明显大于对照组,尿道内口漏斗形成率也明显高于对照组（P〈0．05）。结论经会阴四维超声可用于评估女性压力性尿失禁患者的盆底解剖和功能,值得临床推广应用。     

盆底动态磁共振成像诊断女性压力性尿失禁的临床应用价值

目的 探讨盆底动态磁共振成像(MRI)诊断女性压力性尿失禁(SUI)的临床价值.方法 SUI患者35例,平均年龄51岁.健康女性30例作为对照组,平均年龄55岁.均行盆底动态MRI检查,分别于静息期及力排期进行快速梯度回波T2加权矢状面扫描,以耻尾线(PCL)作为参照标志,分别测量静息期及力排期膀胱尿道连接部的移动度和膀胱尿道后角以及尿道倾斜角3项指标.统计学分析2组MRI测定指标的差异.结果 静息期2组膀胱尿道连接部均位于PCL以上.力排期SUI组膀胱尿道连接部下移距离为(-0.9±1.1)cm,对照组为(-0.1±0.3)cm,组间差异有统计学意义(P＜0.001).力排期SUI组膀胱尿道后角为(156±36)°,倾斜角为(65±37)°;对照组分别为(113±28)°,(17±21)°,组间差异均有统计学意义(P＜0.05).结论 盆底动态MRI诊断SUI简单易行,有较大的临床价值.     

超声技术在女性压力性尿失禁诊断中的价值

尿失禁是一种盆底功能障碍性疾病,好发人群为中老年妇女,而压力性尿失禁(stress urinary incontinence,SUI)是最常见的类型,其国外报道的发病率约8.1％～41.6％[1],国内报道约40％左右,且有逐年升高的趋势.超声技术在尿失禁的诊断中的展开,尤其在SUI的诊断中提高了SUI的诊断率,且为治疗提供了有效依据.     

MRI检查在女性压力性尿失禁临床诊断中的应用价值

目的 探讨MRI检查在女性压力性尿失禁(SUI)诊断中的应用价值. 方法 SUI患者16例,年龄48～66岁,中位年龄58岁;腹压下漏尿病史2～15年,中位数6年.患者术前均行MRI检查.均采用经闭孔尿道中段吊带术(transobturator tension-free tape,TOT)治疗.28例正常女性MRI检查作为对照组,年龄30～55岁,中位年龄45岁;无盆腔疾病史. 结果 对照组28例T1WI和T2WI上尿道支持韧带均表现为细条状偏低信号,尿道周围韧带显示率为89％(25例);尿道旁韧带双侧为75％(21例),单侧为25％(7例);耻骨尿道韧带近、中、远侧分别为100％(28例)、10％(3例)、7％(2例);尿道下韧带为100％.肛提肌在T1 WI、T2WI像上呈中等信号,显示率为100％(28例).16例SUI患者尿道支持韧带表现为松弛、断裂,发生在一组(4例)或多组(12例)韧带.松弛见于尿道周围韧带14例,尿道旁韧带2例,近侧耻骨尿道韧带10例;断裂见于尿道周围韧带2例,尿道旁韧带5例,近侧耻骨尿道韧带6例,尿道下韧带7例,其余呈正常表现或未显示.16例患者肛提肌均呈松弛改变,其中4例伴宫颈及阴道前、后壁膨出. 结论 MRI可以清晰显示女性SUI患者尿道支持结构的薄弱,同时显示宫颈及阴道的膨出,从而可为临床医生诊断与治疗提供影像学依据.     

压力性尿失禁动物模型的建立

目的 探讨压力性尿失禁(SUI)老鼠模型建立的有效方法,为深入研究SUI的发病机制提供有价值的研究对象.方法 50只Sprague-Dawley大鼠雌雄合笼(合笼比例4∶1),分娩后随机分成两组,即第一组(12只)和第二组(28只).第一组对其常规饲养,不做任何特殊处理.第二组对已育大鼠采用阴道球囊扩张4 h模拟难产,两周后重复一次,常规饲养1个月后切除双侧卵巢.8周后,两部分大鼠均行尿流动力学检查测膀胱最大容量(MBC)和腹部漏尿点压力(ALPP)及喷嚏实验,尿动力学检测完毕后从第二组随机筛选出压力性尿失禁成年已育雌性大鼠模型(12只).结果 对照组和实验组大鼠漏尿点压力值分别为(48.00±1.74)cmH2O和(32.94±1.63)cmH2O,差异有统计学意义(p＜0.05);最大膀胱容量为(2.02±0.19)ml和(1.29±0.16)ml,差异有统计学意义(p＜0.05);喷嚏实验见实验组有13只大鼠表现阳性(阳性率52%),对照组全部阴性.结论 阴道球囊扩张联合双侧卵巢切除可以成功建立压力性尿失禁大鼠模型.     

盆底肌功能锻炼联合仿生物理治疗对产后压力性尿失禁的影响

目的 探讨盆底肌功能锻练辅助仿生物理治疗产后压力性尿失禁的效果.方法 将136例产后1～2 a的门诊压力性尿失禁病人,随机分为观察组(71例)和对照组(65例).观察组进行盆底肌功能锻练联合仿生物理治疗,对照组进行单纯的Kegel盆底肌功能锻练,疗程均为12周.疗程结束后采用尿垫试验评估疗效.结果 观察组58例患者好转...     

女性压力性尿失禁大鼠模型

压力性尿失禁是女性的常见病，发病率高，致病因素复杂，基础研究薄弱。建立动物模型可为这一疾病的研究提供材料。实验研究可根据模拟人类产伤、雌激素减退、盆底组织去神经化等建立动物模型。各模型的建模依据、建模方法及方法优缺点各有不同，掌握这些不同可为压力性尿失禁大鼠模型的建立提供帮助。     

盆底生物反馈联合电刺激治疗女性压力性尿失禁

目的探讨盆底生物反馈联合电刺激治疗女性压力性尿失禁（stress urinary incontincnce,SUI）和压力/急迫混合性尿失禁（mixed urinary incontinence,MUI）的临床效果。方法2006年5月-2007年6月对40例轻中度女性尿失禁患者（SUI 22例,MUI 18例）,采用生物反馈治疗仪进行盆底生物反馈联合电刺激的训练治疗,治疗时间20-30 min,3次/周,疗程2个月。结果40例均获随访,平均8.9（3-14）个月。治愈14例（35.0%）,改善16例（40.0%）,无效10例（25.0%）,总有效率为75.0%;其中SUI有效率为77.3%（17/22）,MUI有效率为72.2%（13/18）。除少数患者插入探头时有轻微不适感外,无其他明显不适,无阴道感染等不良反应发生。但有5例治疗有效的患者症状复发。结论盆底生物反馈联合电刺激治疗女性轻中度SUI或MUI安全有效、治愈率较高。治疗后如能继续坚持Kegel操盆底肌锻炼有助于预防尿失禁的复发。     

压力性尿失禁动物模型的建立

Objectives To investigate the effective methods of establishing the rat model of stress urinary incontinence (SUI). Methods 50 Sprague - Dawley rats were caged male and female together (co-cage ratio of 4:1), were randomly divided into two groups after giving birth, the first group (12) and the second group (28). To the first group, we only choose conventional breeding, without any special treatment. The second group we choose female rats after vaginal labour. Their vagina canal was overspread by air ballonet for 4 hours to simulate delivery trauma. Two weeks after the vagina was overspread with the same method again. After another one month ovariectomy was performed on them then conventional breeding for eight weeks, after underwent urodynamic testing maximum bladder capacity (MBC) and abdominal leak point pressure (ALPP) and the sneeze test, after urodynamic testing we randomly choose 12 femal rats stress urinary incontinence (SUI) models from the second group ss for the experimental group(stress urinary incontinence SUI model). Results The modified abdominal leak point pressure of control group and experimental group were (48.00 ± 1.74) cmH2O and (32.94±1.63) cmH2O,the difference was significant (p＜0.05); the maximum cystometries were (2.02±0.19) ml and (1.29±0.16) ml, the difference was significant (p＜0.05); sneeze test, the positive rates of sneeze test of model rat were 13/15(52%), All of the control rats were negative. Conclusions Stress urinary incontinence rats model can be successfully established by vagina balloon dilatation combined with ovariectomy.     

Ultrasonography in stress urinary incontinence

Evaluation of the urethrovesical junction in stress urinary incontinence is essential. For this reason the Q-tip test, a clinical test with debatable specificity; lateral cystourethrography, a conventional method; and videourethrocystography, a sophisticated method, have been in use. Because ultrasonography is inexpensive, reliable, easy to apply and free of any contrast material and X-ray exposure, it has practically replaced all the former methods in the evaluation of the urethrovesical junction in stress urinary incontinence patients within the last decade.     

TVT-O治疗女性压力性尿失禁的疗效观察

目的 探讨评价经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效.方法 回顾性分析2008年9月至2011年9月采用TVT-O治疗SUI18例进行疗效观察.结果 手术时间15 ～45min,平均25 min,术中出血20 ～ 60ml,平均40ml.拔管后尿失禁消失15例,增加腹压后偶有尿液溢出3例.随访3～l2个月,平均6个月,无一例复发.结论 TVT-O治疗SUI操作简单安全,创伤小,并发症少,疗效可靠,是一种理想治疗方法.     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人盆底肌康复研究现状

目的研究阴道锥体训练联合生物反馈盆底肌治疗尿失禁老年人的临床疗效及对盆底肌的影响。方法选取84例从2016年9月至2018年3月本院收治的尿失禁老年患者进行研究,以随机抽签法将其均分为联合组及对照组,每组42例。对照组予以常规盆底肌训练治疗,联合组则予以阴道锥体训练联合生物反馈盆底肌治疗。对比两组在临床疗效、治疗前后盆底肌力情况、治疗前后尿动力学参数指标水平以及生活质量变化情况等方面的差异。结果联合组与对照组在总有效率方面比较,前者高于后者(P<0.05)。治疗后联合组盆底肌力分级为Ⅳ级、Ⅴ级的人数占比相比对照组较高(P<0.05)。治疗后联合组与对照组在VLPP、PMUC水平方面比较,前者高于后者(P<0.05)。治疗后联合组与对照组I-QOL评分相比治疗前较高,且联合组相比对照组较高(P<0.05)。结论阴道锥体训练联合生物反馈盆底肌治疗老年尿失禁患者的疗效显著,有利于促进盆底肌力的恢复,且有效改善患者尿动力学参数,提高生活质量,具有较高的临床推广应用价值。     

生物反馈盆底肌肉训练治疗男性获得性尿失禁的体会

目的 探讨生物反馈盆底肌肉训练治疗男性获得性尿失禁效果.方法 61例尿失禁的患者,按照各人意愿将其分为对照组(30例)和实验组(31例).对照组行单纯盆底肌肉训练,实验组接受生物反馈盆底肌肉训练.治疗前后分别计量患者每日自觉尿失禁次数、24h尿垫重量、膀胱残余尿、盆底肌表面肌电信号值.结果 治疗前各项指标差异无统计学意义(P＞0.05).治疗后,实验组与对照组比较,盆腔外伤术后以及神经源性尿失禁次数差异无统计学意义(P＞0.05).余统计量均有差异(P＜0.05).实验组治疗前后比较,神经源性的盆底肌表面肌电信号值为0.076,无差异,余统计量均有差异(P＜0.05).对照组治疗前后比较,神经源性的尿失禁次数以及膀胱残余尿量P分别为0.09、0.05,差异无统计学意义,余统计量均有差异(P＜0.05).结论 生物反馈系统盆底肌肉训练治疗男性获得性尿失禁是一种有效的、治愈率较高的治疗手段.     

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence

The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n=198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period. EDITORIAL COMMENT: This paper is one of only a few looking at the efficacy of a rigorous pelvic floor muscle exercise training regime to help women with incontinence in the postpartum period. Whether or not these results will translate long-term into a lower incidence of urinary incontinence as these women age, is unknown, and may never be known. However, this paper points out that there is a definite benefit from pelvic floor muscle exercise for the treatment of postpartum incontinence, and we can use this information to more strongly counsel our patients in the use of these exercises.     

单切口经阴道可调节AjustTM吊带治疗女性压力性尿失禁16例临床分析

目的 评估AjustTM吊带系统手术治疗女性压力性尿失禁(SUI)的安全性和疗效.方法 2013年4月～2013年11月共收集SUI患者16例,应用单切口可调节AjustTM吊带系统进行治疗,记录并分析所有患者的临床资料,包括治愈率、满意度和手术并发症等.结果 16例手术均获得成功,手术时间为9～ 17min,失血量10 ～35mL,平均18±4.5mL.膀胱等盆腔脏器及尿道无损伤,围手术期无会阴血肿的发生,无切口感染发生.16例尿失禁均消失,随访半年无复发.结论 单切口A justTM吊带治疗SUI创伤小,并发症少,疗效良好.     

静态尿道压力测定和应力性尿道压力测定在女性真性压力性尿失禁诊断中的应用

目的探讨静态尿道压力测定(RUPP)和应力性尿道压力测定(SUPP)在女性真性压力性尿失禁(GSI)诊断中的应用价值。方法对30例临床诊断为GSI的患者进行RUPP及SUPP测定,比较其结果,以15例正常女性作为对照。结果静态尿道压力测定,SCI组的最大尿道关闭压和控制带长度较正常对照组小。应力性尿道压力测定中,患者压力传导率(PTR)及尿道关闭压(UCP)以多次咳嗽的平均值计算,GSI组PTR及UCP各为(0.63±0.24)、(-26.58±21.43cmH2O),而正常组PTR及UCP各为(1.78±0.12)与(83.42±37.23cmH2O)。两组间上述指标的差异均有显著性意义(p<0.01)。结论SUPP和RUPP在GSI的诊断中均具有一定意义,对于症状较轻的尿失禁患者的诊断,两者联合应用可以提高GSI的诊断水平。     

经阴道尿道中段线性悬吊术治疗非复杂性压力性尿失禁的临床疗效观察

目的:探究经阴道尿道中段线性悬吊术治疗非复杂性压力性尿失禁(SUI)的临床疗效。方法:选取2016年12月至2019年1月在本院就诊的非复杂性SUI患者60例,采用随机数字表法分为观察组和对照组,每组各30例,对照组采用无张力尿道中段线性悬吊带术(TVT)治疗,观察组采用经阴道尿道中段线性悬吊术治疗,比较两组患者的临床...     

Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women

The purpose of the study was to provide estimates of stress urinary incontinence (SUI) and practice of pelvic floor muscle training (PFMT) postpartum as well as counseling during and after pregnancy among Hispanic women. Two hundred Hispanic women were surveyed 6 months postpartum. Twenty-three percent had SUI with onset primarily during pregnancy (70%). Only 20% had received information regarding SUI and PFMT during pregnancy or postpartum. Most women not counseled wished they were (81%). Less counseling occurred among Hispanic women with lower levels of education (odds ratio [OR] = .39; 95% confidence interval [CI] = 0.19–0.82; p = 0.02) and those whose primary language was Spanish (OR = .36; 95% CI = 0.15–0.87; p = 0.02), while higher rates occurred among women with a forceps delivery (OR = 2.94; 95% CI = 1.06–7.78; p = 0.03). Fifty-seven percent of women counseled practiced the exercises. Primary reasons for noncompliance were belief that PFMT would not help (47%), and not understanding the instructions (39%). SUI and PFMT counseling is low among Hispanic women. Most women desire such information, and improvement in performance of PFMT among this group is possible. An erratum to this article can be found at