Objective: To evaluate transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction. Methods: Eighty-three patients with severe pelvic organ prolapse received surgeries in Fuzhou General Hospital from September 2014 to September 2015, dividing into two groups: 27 patients were selected to receive transvaginal mesh (TVM) pelvic floor reconstruction surgery with tension-free vaginal tape-Abbrevo (TVT-Abbrevo) incontinence surgery, named TVM+TVT-Abbrevo group; 56 patients were selected to receive TVM pelvic floor reconstruction surgery only, named TVM group. The ultrasonic parameters at rest, on contraction and Valsalva condition respectively were observed and measured, including the bladder neck descent (BND), urethral rotation angle, retrovesical angle, levator urethra gap (LUG), the existence of bladder neck funneling, position of the tape, by using 2D and 3D transperineal ultrasound. Results: The two groups were compared with the ultrasonic parameters before and after operation: two groups of patients with postoperative BND [(2.3±0.5) versus (3.1±0.7) cm, (1.6±0.4) versus (3.6±0.4) cm] were significantly reduced, the difference was statistically significant (P=0.02, P<0.01). The two groups of LUG before and after operation [(3.62±0.45) versus (3.26±0.92) cm, (2.96±0.47) versus (2.72±0.38) cm] both had significant difference by maximum Valsalva (P<0.01, P=0.04). There was statistical significance difference of urethral rotation angle in TVM+TVT-Abbrevo group by maximum Valsalva (P=0.01). Observation of morphology: (1) 2 patients with difficulty in urination in TVM+TVT-Abbrevo group, ultrasound showed when the position of the bladder down the urethra discount; 4 patients with stress urinary incontinence (SUI), ultrasound showed slings off or release. (2) One patient with difficulty in urination in TVM group, but ultrasound showed lower urinary tract anatomy were normal; 5 patients with SUI, ultrasound showed the position of the bladder neck were significantly lower in 3 patients, showing high mobility, and the other 2 patients had a larger urethral diameter, showing a tendency of natural deletion. Conclusion: s Anatomy of lower urinary tract could be clearly showed by transperineal sonography. This could provide imaging support for the diagnosis of lower urinary tract symptoms after pelvic floor reconstruction.
目的： 探讨经会阴超声检查对盆底重建手术后下尿路结构的评估作用。 方法： 纳入2014年9月至2015年9月在南京军区福州总医院因重度盆腔器官脱垂行手术治疗的患者83例，其中行经阴道植入网片盆底重建术的同时行经闭孔无张力尿道中段悬吊带术的患者27例为盆底重建+抗尿失禁术组，单纯行经阴道植入网片盆底重建术者56例为盆底重建组。在二维及三维模式下进行经会阴超声检查，获得两组患者术前和术后静息、缩肛及最大Valsalva动作下膀胱颈移动度、尿道倾斜角、尿道膀胱后角、肛提肌-尿道间隙、有无尿道漏斗形成及术后吊带的形态等参数，采用自身对照设计进行术前、术后的对比分析。 结果： 术后膀胱颈移动度盆底重建组[分别为（2.3±0.5）、（3.1±0.7）cm]、盆底重建+抗尿失禁术组[分别为（1.6±0.4）、（3.6±0.4）cm]患者均较术前明显减小，分别比较，差异均有统计学意义（P=0.02、P<0.01）。最大Valsalva动作时，两组患者术前与术后肛提肌-尿道间隙分别比较[盆底重建组分别为（3.62±0.45）、（3.26±0.92）cm，盆底重建+抗尿失禁术组分别为（2.96±0.47）、（2.72±0.38）cm]，差异均有统计学意义（P<0.01、P=0.04）。盆底重建+抗尿失禁术组手术前、后在最大Valsalva动作时尿道倾斜角有差异（P=0.01）。术后超声下的形态观察：（1）盆底重建+抗尿失禁术组，术后出现排尿困难者2例，超声下显示在Valsalva动作时，膀胱底向阴道前壁膨出下移时尿道（膀胱颈及尿道远段）发生折叠、扭曲；术后出现压力性尿失禁者4例，超声下显示2例患者吊带有脱落现象，另2例在最大Valsalva动作时吊带的移动位置较大。（2）盆底重建组，术后出现排尿困难者1例，超声下显示下尿路解剖位置未见异常；术后出现压力性尿失禁者5例，超声下可见3例患者在最大Valsalva动作时膀胱颈位置下移明显，且膀胱底向后下方移动的幅度较大，表现为高活动性，另2例患者尿道内径增宽，有尿道自然闭合功能缺失倾向。 结论： 经会阴超声检查能够清晰显示下尿路的解剖结构，可为盆底重建手术后评估下尿路症状的原因提供直观的影像学证据。.
Zhonghua fu chan ke za zhi. 2017 Sep 25 [Epub]
X L Zhong, J Song, Y L Xu, X L Lyu, X H Zhong, A P Wang, Y F Song
Department of Obstetrics and Gynecology, Fuzhou General Hospital, Fujian Medical University, Fuzhou 350025, China.