尿道内口漏斗各参数诊断女性压力性尿失禁

目的 观察尿道内口漏斗形成后各参数对女性压力性尿失禁（SI）的诊断价值。方法 回顾性分析681例接受经会阴实时三维盆底超声检查的女性，根据尿流动力学检查分为SI组（n=145）与对照组（n=536）。观察并比较2组最大瓦尔萨尔瓦动作时尿道内口漏斗形成率，测量其开放长度、宽度、深度、面积、周长及角度，并计算开放长度占尿道长度的比例；绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价各参数对SI的诊断效能。结果 最大瓦尔萨尔瓦动作下，SI组尿道内口漏斗各参数值均高于对照组（P均<0.05）。尿道内口漏斗形成后各参数对诊断SI均有一定价值，以开放角度的诊断效能最高，截断值取5.33°时，AUC为0.78，敏感度、特异度和准确率分别为53.10%、83.21%和76.80%。结论 尿道内口漏斗各参数对于诊断SI均有一定价值，以尿道内口漏斗开放角度的诊断效能最高。

Parameters of internal urethral orifice funnel for diagnosis of female stress incontinence

Objective To observe the diagnostic value of the parameters of internal urethral orifice funnel for diagnosis of female stress incontinence (SI). Methods Data of 681 women who underwent transperineal real-time three-dimensional pelvic floor ultrasound examination were retrospectively analyzed. The patients were divided into SI group (n=145) or control group (n=536) according to outcomes of urodynamic examination. The occurrence rate of internal urethral orifice funnel was observed under maximum Valsalva maneuver, and then parameters of funnel opening, including the length, width, depth, area, perimeter, angle and the ratio of opening length to urethral length were measured and compared between groups. The receiver operating characteristic (ROC) curves were drawn, the areas under the curves (AUC) were calculated, and the diagnosis efficacies of different parameters were accounted and compared between groups.Results The parameters of internal urethral orifice funnels in SI group were higher than those in control group under the maximum Valsalva maneuver (all P<0.05). All the parameters were valuable for diagnosis of SI, while the opening angle of internal urethra had the best diagnostic value. Taken 5.33° as the optimal cut-off value, the AUC of the opening angle of internal urethra for diagnosing SI was 0.78, and the sensitivity, specificity and accuracy was 53.10%, 83.21% and 76.80%, respectively. Conclusion The parameters of internal urethral orifice funnel had certain diagnostic value for SI, among which the open angle of the internal urethra funnel had the best diagnostic efficiency.