Expectations of Stress Urinary Incontinence Surgery in Patients With Mixed Urinary Incontinence

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients’ expectations.Key words: Urodynamics, Mixed urinary incontinence, Sling, Anti-incontinence surgery, Urgency incontinenceIt has been estimated that approximately 30% of women with urinary incontinence have mixed urinary incontinence (MUI). Degree of bother is higher among women with MUI compared with those who have pure stress urinary incontinence (SUI).¹ MUI can be a very challenging and costly condition to treat.^2,3 Patients with MUI are often offered conservative therapy such as physical therapy, weight-loss strategies, and behavioral modification. Some patients also benefit from treatments aimed directly at urgency, frequency, and urgency incontinence (overactive bladder), which currently include pharmacologic therapy (antimuscarinic or β-3 agonists), chemodenervation (botulinum toxin), or neuromodulation (sacral or posterior tibial nerves).⁴ However, many patients with MUI progress to surgical therapies for treatment of SUI. This article reviews the literature available that can help clinicians manage expectations of SUI surgeries on patients with MUI.     

Developing Repair Materials for Stress Urinary Incontinence to Withstand Dynamic Distension

Background

Polypropylene mesh used as a mid-urethral sling is associated with severe clinical complications in a significant minority of patients. Current in vitro mechanical testing shows that polypropylene responds inadequately to mechanical distension and is also poor at supporting cell proliferation.

Aims and Objectives

Our objective therefore is to produce materials with more appropriate mechanical properties for use as a sling material but which can also support cell integration.

Methods

Scaffolds of two polyurethanes (PU), poly-L-lactic acid (PLA) and co-polymers of the two were produced by electrospinning. Mechanical properties of materials were assessed and compared to polypropylene. The interaction of adipose derived stem cells (ADSC) with the scaffolds was also assessed. Uniaxial tensiometry of scaffolds was performed before and after seven days of cyclical distension. Cell penetration (using DAPI and a fluorescent red cell tracker dye), viability (AlamarBlue assay) and total collagen production (Sirius red assay) were measured for ADSC cultured on scaffolds.

Results

Polypropylene was stronger than polyurethanes and PLA. However, polypropylene mesh deformed plastically after 7 days of sustained cyclical distention, while polyurethanes maintained their elasticity. Scaffolds of PU containing PLA were weaker and stiffer than PU or polypropylene but were significantly better than PU scaffolds alone at supporting ADSC.

Conclusions

Therefore, prolonged mechanical distension in vitro causes polypropylene to fail. Materials with more appropriate mechanical properties for use as sling materials can be produced using PU. Combining PLA with PU greatly improves interaction of cells with this material.     

女性压力性尿失禁患者盆底三维超声显像初步研究

目的:通过三维超声对正常未孕妇女及产后压力性尿失禁(SUI)患者的盆底结构显像,研究SUI患者的膀胱颈尿道活动度及肛提肌变化,评估三维超声显像对女性盆底病变的诊断价值.方法:分别对研究组和对照组行盆底结构三维超声检查,测量膀胱尿道连接部的直接移动度(UVJ-M)、张力期膀胱尿道后角、静息期及张力期耻骨直肠肌厚度、耻骨直肠肌夹角,观察肛提肌形态.结果:SUI研究组UVJ-M 15.93± 2.07mm,较对照组7.64± 1.37mm增大(P＜0.01),研究组张力期膀胱尿道后角145.90±22.03°,较对照组106.49±14.32°增大(P＜0.01),研究组静息期耻骨直肠肌厚度6.39±0.48小于对照组6.71±0.69(P＜0.05),研究组张力期耻骨直肠肌厚度6.13±0.49小于对照组6.64± 0.61(P＜0.05),静息期研究组耻骨直肠肌夹角70.08±3.15大于对照组69.45±2.19°,但无统计学意义(P＞0.05),张力期75.49±3.92大于对照组70.35±1.51° (P＜0.01).结论:三雏超声显像能直观有效地观察女性尿道、肛提肌等盆底结构,对诊断压力性尿失禁是一个有意义的辅助手段.     

A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence

Background

Acupuncture is a potential conservative therapy for women with stress urinary incontinence (SUI). There is limited evidence to support its effectiveness due to the poor quality of existing studies.

Methods

We performed a pilot randomized, controlled trial to preliminarily assess the efficacy of electroacupuncture (EA) in women with pure SUI. A total of 80 women with pure SUI were randomly assigned to receive EA with deep needling at BL33 and BL35 (n = 40) or sham EA with non-penetrating needling at sham acupoints (n = 40) three sessions per week for 6 weeks. The women were followed for 24 weeks. The primary outcome was the change from baseline in the amount of urine leakage measured by a 1-hour pad test after 6 weeks. The secondary outcomes included the 72-hour incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, and patient self-evaluation of therapeutic effect. Adverse events (AEs) were monitored throughout the trial.

Results

The median decrease from baseline of urine leakage measured by the 1-hour pad test was 2.5 g [interquartile range (IQR): 1.80–14.6 in the EA group, which was greater than the median decrease of 0.05 g (IQR: -2.80–+0.50) in the sham EA group after 6 weeks (p<0.01). The differences between groups in the decrease from baseline of 72-hour IEF became statistically significant at week 30 with a median decrease of 3.25 g (IQR: 1.25–5.69) in the EA group, and a median decrease of 1.00 g (IQR: -0.69–+2.88) in the sham EA group (p = 0.01). The participants in the EA group showed greater decreases in ICIQ-SF score and higher ratings in the help they received from the treatment than those in the sham EA group at weeks 6,18 and 30 (all p<0.05). No obvious AEs were observed in either group.

Conclusion

EA may effectively and safely relieve urinary incontinence symptoms and improve quality of life in women with pure SUI. EA demonstrated more than a placebo effect. Since this is a pilot study, results should be interpreted with caution.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02445573","term_id":"NCT02445573"}}NCT02445573.     

护理干预对成年女性压力性尿失禁患者的影响

目的：探讨护理干预对成年女性压力性尿失禁患者的影响。方法：在患者自愿参与的情况下,随机抽取浏阳市市区80名有压力性尿失禁症状的成年女性,对她们进行护理干预,并对干预效果进行评价。结果：护理干预后,患者压力性尿失禁发作次数显著减少,盆底肌肉张力显著提高,漏尿量显著减少。结论：护理干预可减轻成年女性压力性尿失禁症状,减轻患者的身心痛苦,提高压力性尿失禁患者的生活质量。     

成年女性压力性尿失禁患者心理健康状况调查分析

目的:探讨成年女性压力性尿失禁患者的心理健康状况,提出护理干预方法。方法:采用SCL-90及自编一般资料,对浏阳市市区80名有压力性尿失禁症状的成年女性进行心理健康自评调查,另80名无压力性尿失禁症状的成年女性为对照。结果:有压力性尿失禁症状的成年女性SCL-90总分、阳性项目数、阳性项目均分及躯体化、人际关系、抑郁、焦虑、敌对、恐怖和精神病性等因子评分均明显高于对照组及常模组(P<0.05)。结论:成年女性压力性尿失禁患者心理健康状况不容乐观,应引起重视,并对其进行护理干预,加强对她们的心理疏通,可以提高疾病的防治效果。     

雌激素治疗绝经妇女压力性尿失禁的临床报告

目的:观察雌激素对绝经妇女压力性尿失禁的疗效.方法:将40例绝经妇女压力性尿失禁患者随机分为实验组和对照组,前者采用雌激素治疗联合盆底肌肉锻炼,后者单纯盆底锻炼.治疗后观察评定尿失禁改善情况,比较分析雌激素的疗效.结果:实验组和对照组总有效率依次为100%和50%,差异具有显著性(P＜0.01).实验组用药后血清促卵泡素水平显著下降,雌激素水平上升至卵泡早期水平,体重、血脂及肝肾功能变化均无统计学意义.结论:雌激素对绝经妇女压力性尿失禁疗效较好,建议临床推广.     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁3 年随访分析

目的:探讨经闭孔无张力尿道中段悬吊术(TVT-O术)治疗女性压力性尿失禁的中期疗效。方法:选择2007年5月-2011年5月于我院行TVT-O术治疗压力性尿失禁女性患者172例,应用压力性实验评估术前及术后短期疗效,持续3年的随访,分析中期疗效、尿流动力学参数、术后生活质量等重要数据。结果:术后1年,患者主观治愈率为93.0%,客观治愈率为94.8%,术后3年主观治愈率为91.3%,客观治愈率为93.0%,术后1年与术后3年比较均无统计学意义(均P>0.05);术后1、3年自我感觉模糊数字评分、I-QOL评分、最大流速及残余尿量较术前均有改善,差异均有统计学意义(均P<0.05);而术后1年与术后3年比较差异均无统计学意义(均P>0.05);随访期间主要并发症为腹股沟疼痛及排尿困难,均可控,未严重影响预后。结论:TVT-O治疗女性压力性尿失禁的中期疗效良好,并发症低,安全可靠,具备推广价值。     

盆底肌力强度对产后压力性尿失禁发生的预测作用研究

目的:探讨盆底肌力强度对产后压力性尿失禁发生的预测作用。方法:2013年4月至2014年3月,随机抽取200例在本院产检和分娩的产妇,收集其临床资料,并在产后6个月检测其盆底肌力强度,根据产妇是否有压力性尿失禁分为尿失禁组和非尿失禁组,运用双变量分析、分类和回归树等统计方法,建立一个产后压力性尿失禁的预测模型。结果:尿失禁组和非尿失禁组在慢性咳嗽、孕前已有尿失禁症状、孕期有新发尿失禁症状以及盆底肌力强度等4项因素中有统计学差异(P0.05);分类与回归树预测模型提示盆底肌力强度小于等于35.5 cm H2O、孕前已有尿失禁症状、新生儿出生体重大于2988 g及孕期有新发尿失禁症状对产后尿失禁有预测作用,其中盆底肌力强度的预测作用最显著。结论:根据预测模型筛选出产后压力性尿失禁的高危人群,及早对其进行干预,对减少产后压力性尿失禁的发生率有一定的临床意义,而预测模型的构建还需进一步的研究和验证。     

Diagnosis,Evaluation, and Treatment of Mixed Urinary Incontinence in Women

Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.Key words: Mixed urinary incontinence, Detrusor overactivity, Stress incontinence, Urge incontinence, Urodynamic stress incontinence, Pelvic organ prolapse, Transvaginal tapeMixed urinary incontinence (MUI) is the leading cause of incontinence in the community and hospital setting.¹ The term refers to a combination of symptoms, with the patient exhibiting features of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI); it may also refer to a combination of features of urodynamic SUI and detrusor hyperactivity.¹ The current International Continence Society guidelines define MUI as a complaint of the involuntary loss of urine during exertion, sneezing, or coughing, as well as leakage associated with urgency.²The term MUI is extremely broad because it may refer to equal stress and urge symptoms, stress-predominant symptoms, urge-predominant symptoms, urodynamic SUI (USUI) with detrusor overactivity (DO), or USUI with clinical urge symptoms but no DO.³ The challenge of this broad definition is that it leads to inconsistencies when evaluating treatment options and outcomes. In an attempt to validate diagnostic questions that could later be used in an epidemiological survey, Sandvik and colleagues⁴ defined MUI based on subjective answers to a structured questionnaire designed for their study.⁴ SUI was presumed if a positive answer was given to the question: “Do you lose urine during sudden physical exertion, lifting, coughing, or sneezing?” If the patient responded positively to the question: “Do you experience such a strong and sudden urge to void that you leak before reaching the toilet?” then a diagnosis of UUI was presumed. MUI was considered if a positive answer was given to both questions. In contrast, Brubaker and colleagues⁵ reported that strict definitions based on self-reported symptoms do not properly categorize patients as having MUI. Their group believed that patients should be broken down into MUI subgroups of SUI and UUI rather than describing it as a single entity. However, without a precise definition or understanding of the role of these stress and urge subcomponents, the assessment of an intervention for SUI or UUI is challenging.⁶The prevalence rates of MUI vary widely in the literature. In a secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), Brubaker and colleagues⁵ evaluated 655 women for the presence of incontinence and their response to treatment. They found that 50% to 93% of women fell into the category of MUI based on patient-reported answers to the Medical Epidemiologic and Social Aspects of Aging (MESA) and Urinary Distress Inventory (UDI) questionnaires. However, when objective criteria such as urodynamic findings were used, only 8% of women were categorized with MUI. Dooley and associates⁷ compared physical examination findings and responses to the MESA and UDI questionnaires in 551 women with a mean age of 56 ± 16 years. They estimated a prevalence rate of 30% of MUI in all women with urinary incontinence.According to Dooley and associates,⁷ in their cohort, MUI was more bothersome to patients than either pure SUI or UUI. In a cross-sectional population-based study across 6 European countries that included over 300 patients, the effects of overactive bladder (OAB) symptoms on employment, social interactions, and emotional well-being were evaluated by direct interview or a telephone-conducted interview. Irwin and associates⁸ found 32% of patients aged 40 to 64 years reported being depressed. In addition, they determined that symptoms of OAB have a statistically significant negative impact on emotional well-being both at home and at work.We sought to examine the existing literature on MUI and better understand the role urodynamic testing (UDS) plays in its diagnosis. In addition, we sought to examine treatment methods so that better treatment outcomes may be achieved.     

Male Urinary Incontinence: Prevalence,Risk Factors,and Preventive Interventions

Urinary incontinence (UI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials published in English from 1990 to November 2007 on the epidemiology and prevention of UI were identified in several databases to abstract rates and adjusted odds ratios (OR) of incontinence, calculate absolute risk difference (ARD) after clinical interventions, and synthesize evidence with random-effects models. Of 1083 articles identified, 126 were eligible for analysis. Pooled prevalence of UI increased with age to 21% to 32% in elderly men. Poor general health, comorbidities, severe physical limitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidence interval [CI], 1.14–2.1), urinary tract infections (pooled OR 3.49; 95% CI, 2.33–5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI, 1.14–1.61) were associated with UI. Treatment with tolterodine alone (ARD 0.17; 95% CI, 0.02–0.32) or combined with tamsulosin (ARD 0.17; 95% CI, 0.08–0.25) resulted in greater self-reported benefit compared with placebo. Radical prostatectomy or radiotherapy for prostate cancer compared with watchful waiting increased UI. Short-term prevention of UI with pelvic floor muscle rehabilitation after prostatectomy was not consistently seen across randomized, controlled trials. The prevalence of incontinence increased with age and functional dependency. Stroke, diabetes, poor general health, radiation, and surgery for prostate cancer were associated with UI in community-dwelling men. Men reported overall benefit from drug treatments. Limited evidence of preventive effects of pelvic floor rehabilitation requires future investigation.Key words: Urinary incontinence, Risk factors, Rehabilitation, Drug therapyUrinary incontinence (UI) affects substantial proportions of men¹; the estimated prevalence of UI varied from 11% among those aged 60 to 64 years to 31% in older men, and from 16% among white men to 21% among African American men.² Daily UI was reported by 30% to 47% and weekly UI by 15% to 37% of community-dwelling men.² A small proportion (22%) of men with weekly UI episodes ever sought medical care for this problem, whereas 40% of treated men reported moderate to great frustration with continued urine leakage.³Baseline mechanisms of UI include overactive bladder that may result in urge UI and poor urethral sphincter function that can result in primary urethral incompetence and stress UI.^4,5 Baseline mechanisms of incontinence lead to variable definitions, risk factors, and effective interventions to prevent and treat UI.⁵This review was commissioned as background material for a National Institutes of Health Office of Medical Applications of Research State of the Science Conference on Incontinence. We aimed to synthesize evidence of the effectiveness of different clinical interventions to prevent the occurrence and progression of UI in community-dwelling men.     

The Long-Term Influence of Body Mass Index on the Success Rate of Mid-Urethral Sling Surgery among Women with Stress Urinary Incontinence or Stress-Predominant Mixed Incontinence: Comparisons between Retropubic and Transobturator Approaches

Objectives

Mid-urethral sling (MUS) surgery for the treatment of urinary incontinence has been widespread since the introduction of tension-free vaginal tape in the mid-1990s. The majority of studies with short-term follow-up <2 years found no differences in the surgical outcomes according to body mass index (BMI). However, considering the chronic influence of obesity on pelvic floor musculature, it is cautiously speculated that higher BMI could increase stress on pelvic floor and sub-urethral tape, possibly decreasing the long-term success rate in the obese population. We aimed to compare the long-term effects of BMI on the outcomes of MUS between women with retropubic and transobturator approaches.

Methods

We performed a retrospective analysis on 243 consecutive women who received MUS and were followed up for ≥36 months. The influence of BMI on the success rates was separately estimated and the factors for treatment failure were examined using logistic regression in either approach.

Results

The mean follow-up was 58.4 months, and 30.5% were normal weight, 51.0% overweight, and 18.5% obese. Patients received either the retropubic (30.5%) or transobturator (69.5%) approach. The success rates (%) under the transobturator approach differed according to the BMI groups (94.3, 88.6, and 78.6, respectively; P = 0.037) while those under the retropubic approach were not different according to the BMI groups. However, in multivariate models, only the presence of preoperative mixed urinary incontinence (MUI) was proven to be the risk factor for treatment failure in the transobturator approach (OR 6.39, P = 0.003). The percent of subjects with MUI was higher in obese women than in non-obese women with the transobturator approach.

Conclusions

BMI was not independently associated with failures in either approach. Higher success rates in women with lower BMI in the transobturator approach were attributed to the lower percent of preoperative MUI in those with lower BMI.     

三种不同手术方式治疗中老年女性压力性尿失禁疗效及对患者膀胱功能和术后并发症的影响

摘要 目的：探讨耻骨后膀胱尿道悬吊术（Burch）、阴道无张力尿道悬吊术（TVT）及经闭孔经阴道尿道中段悬吊带术（TVT-O）三种不同手术方式治疗中老年女性压力性尿失禁（SUI）疗效及对患者膀胱功能和术后并发症的影响。方法：回顾性分析2019.1-2022.4收治的101例中老年女性SUI患者资料,按手术方式分为Burch组（n=30,Burch术治疗）、TVT组（n=31,TVT术治疗）和TVT-O组（n=40,TVT-O术治疗）,观察三组患者临床疗效和手术情况[手术时间、出血量、住院时间、尿管留置时间],并发症发生率,治疗前后膀胱功能[24h排尿次数、膀胱容量、每次排尿量、残余尿量]及尿道功能指标[尿道长度（FUL）、最大尿道闭合压（MUCP）、Valsalva漏尿点压（VLPP）]变化。结果：Burch组、TVT组、TVT-O组治愈及改善率分别为83.34%、87.10%、87.50%,13.33%、12.90%、12.50%,三组之间比较差异无统计学意义（P>0.05）;TVT组、TVT-O组患者手术时间、出血量、住院时间、尿管留置时间均显著短于Burch组（P<0.05）,且TVT-O组患者手术时间显著短于TVT组（P<0.05）;治疗后,三组患者24 h排尿次数、残余尿量均显著降低（P<0.05）,膀胱容量、每次排尿量、FUL、MUCP、VLPP水平均显著增加（P<0.05）,但三组之间比较差异无统计学意义（P>0.05）;Burch组、TVT组、TVT-O组并发症总发生率分别为20.00%、12.91%、15.00%,三组之间比较差异无统计学意义（P>0.05）。结论：三种术式治疗中老年女性SUI疗效相当,均可有效改善膀胱功能及尿道指标,但TVT与TVT-O术患者康复快,TVT-O手术时间最短,TVT并发症低,可依据患者情况酌情选择。     

聚乙二醇模拟水分胁迫筛选拟南芥突变体的新方法

在以聚乙二醇（PEG）模拟水分胁迫的条件下,分别在拟南芥种子萌发期和幼苗期以25％和30％为选择浓度,根据一种子是否萌发和幼苗能否存活为指标,筛选拟南芥抗水分胁迫突变体。此法操作简单,方便快捷,特别适合实验室进行大规模筛选。我们用这种方法筛选了T—DNA插入的拟南芥突变体库,得到78株可能是拟南芥抗水分胁迫的突变体。     

Myogenic Potential of Whole Bone Marrow Mesenchymal Stem Cells In Vitro and In Vivo for Usage in Urinary Incontinence

Urinary incontinence, defined as the complaint of any involuntary loss of urine, is a pathological condition, which affects 30% females and 15% males over 60, often following a progressive decrease of rhabdosphincter cells due to increasing age or secondary to damage to the pelvic floor musculature, connective tissue and/or nerves. Recently, stem cell therapy has been proposed as a source for cell replacement and for trophic support to the sphincter. To develop new therapeutic strategies for urinary incontinence, we studied the interaction between mesenchymal stem cells (MSCs) and muscle cells in vitro; thereafter, aiming at a clinical usage, we analyzed the supporting role of MSCs for muscle cells in vitro and in in vivo xenotransplantation. MSCs can express markers of the myogenic cell lineages and give rise, under specific cell culture conditions, to myotube-like structures. Nevertheless, we failed to obtain mixed myotubes both in vitro and in vivo. For in vivo transplantation, we tested a new protocol to collect human MSCs from whole bone marrow, to get larger numbers of cells. MSCs, when transplanted into the pelvic muscles close to the external urethral sphincter, survived for a long time in absence of immunosuppression, and migrated into the muscle among fibers, and towards neuromuscular endplates. Moreover, they showed low levels of cycling cells, and did not infiltrate blood vessels. We never observed formation of cell masses suggestive of tumorigenesis. Those which remained close to the injection site showed an immature phenotype, whereas those in the muscle had more elongated morphologies. Therefore, MSCs are safe and can be easily transplanted without risk of side effects in the pelvic muscles. Further studies are needed to elucidate their integration into muscle fibers, and to promote their muscular transdifferentiation either before or after transplantation.     

实时三维盆底超声对产后压力性尿失禁患者疗效评估作用及与尿动力学的相关性分析

摘要 目的：探讨实时三维盆底超声对产后压力性尿失禁（SUI）患者疗效评估作用及与尿动力学的相关性。方法：选择2020年4月至2022年12月石家庄市人民医院收治的139例产后SUI患者,均接受盆底生物反馈电刺激联合盆底肌锻炼治疗。治疗前后分别进行实时三维盆底超声检查和尿动力学检查。比较治疗前后实时三维盆底超声参数、尿动力学指标差异。Pearson法分析实时三维盆底超声参数与尿动力学指标的相关性。结果：实时三维盆底超声图像特征显示：治疗前盆膈裂孔内的结构疏松,回声变弱,盆腔器官结缔组织疏松,间隙增宽,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较大;治疗后盆膈裂孔两侧耻骨直肠肌对称,耻骨内脏肌呈带状高回声,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较治疗前降低。产后SUI患者治疗后静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度均较治疗前降低（P＜0.05）,腹压漏尿点压、最大逼尿肌压力均较治疗前增加（P＜0.05）。产后SUI患者静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度与最大逼尿肌压力、腹压漏尿点压呈负相关（P＜0.05）,与最大膀胱容量和残余尿量无关（P＞0.05）。结论：产后SUI患者经盆底生物反馈电刺激联合盆底肌锻炼治疗后实时三维盆底超声参数较治疗前降低,与尿动力学改善有关。临床可通过实时三维盆底超声检查,对产后SUI患者进行临床疗效评价,以指导临床治疗。     

盆底超声参数预测剖宫产术后压力性尿失禁的效能及其与盆底组织E-cadherin和Vimentin表达的关系研究

摘要 目的：研究盆底超声参数预测剖宫产术后压力性尿失禁（SUI）的效能及其与盆底组织钙粘附蛋白E（E-cadherin）和波形蛋白（Vimentin）表达的关系。方法：选取2020年1月～2021年1月湖南省妇幼保健院收治的124例剖宫产患者。将其按照是否发生SUI分为SUI组18例以及无SUI组106例。对所有患者均进行盆底超声检查,比较两组静息期（R）、张力期Valsalva动作（V）的膀胱尿道后角（PUA）以及膀胱颈到耻骨联合下缘水平垂直距离（BNS）,膀胱颈移动度（BND）、尿道旋转角度（UR）。通过受试者工作特征（ROC）曲线分析盆底超声参数预测剖宫产术后SUI的效能。另外,对比两组盆底组织E-cadherin和Vimentin mRNA水平,采用Pearson相关性分析各项盆底超声参数和盆底组织E-cadherin、Vimentin mRNA表达的相关性。结果：SUI组R-PUA、V-PUA、BND以及UR均高于无SUI组,而R-BNS以及V-BNS均低于无SUI组（均P＜0.05）。ROC曲线分析结果：各项盆底超声参数联合预测剖宫产术后SUI的效能均优于各项参数单独预测。SUI组盆底组织E-cadherin mRNA水平低于无SUI组,而Vimentin mRNA水平高于无SUI组（均P＜0.05）。经Pearson相关性分析发现,R-PUA、V-PUA、BND、UR均和盆底组织E-cadherin mRNA水平呈负相关关系,与Vimentin mRNA水平呈正相关关系;而R-BNS、V-BNS均和盆底组织E-cadherin mRNA水平呈正相关关系,与Vimentin mRNA水平呈负相关关系（均P＜0.05）。结论：盆底超声参数预测剖宫产术后SUI的效能较高,且和盆底组织E-cadherin、Vimentin表达有关。