Mixed urinary incontinence: can pelvic floor ultrasonography predict the success of retropubic midurethral synthetic sling?
10.3969/j.issn.1009-8291.2024.12.009
- VernacularTitle:盆底超声在尿道中段吊带术治疗混合性尿失禁中的应用
- Author:
Wenxin XU
1
;
Jiayi LI
1
;
Qixiang SONG
1
;
Lei XU
1
;
Yiyuan GU
1
;
Yunyue GUO
2
;
Xiaowei SUN
2
;
Wei XUE
1
Author Information
1. Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
2. Clinical Research Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
- Publication Type:Journal Article
- Keywords:
mixed urinary incontinence;
pelvic floor ultrasonography;
midurethral synthetic sling;
urodynamics
- From:
Journal of Modern Urology
2024;29(12):1069-1073
- CountryChina
- Language:Chinese
-
Abstract:
[Objective] To explore the application of pelvic floor ultrasonography in the treatment of mixed urinary incontinence (MUI) by transvaginal retropubic midurethral synthetic sling (RMUS), in order to understand the relationship between the morphological changes of pelvic floor structures and the efficacy of RMUS. [Methods] Clinical data of 44 female MUI patients undergoing RMUS during Jan.2018 and Dec.2020 were retrospectively analyzed.Urodynamics detected detrusor overactivity (DO) in 9 cases (20.5%). During RMUS procedure, the tension of the sling was adjusted based on the anatomical landmarks. The changes of ultrasonic parameters before and after operation, the relationship between the ultrasonic results, surgical efficacy and urodynamic results were analyzed. [Results] The patients averaged (58.59±9.08) years, with the body mass index being 24.71±2.77.The subjective cure rate was 91.3% (21/23) 3 months after surgery, and 85.0% (34/40) 2 years after surgery.Pelvic floor ultrasonography showed significant differences in posterior urethravesical angel at rest and during Valsalva, bladder neck descent distance and the rate of urethral funneling during Valsalva (P<0.05). According to the group analysis of the preoperative ultrasonic results, there was no statistical significance in the subjective cure rate between the funneling group and the non-funneling group during Valsalva, and the bladder neck non downward group/mild downward group/moderate downward group/severe downward group during Valsalva 3 months and 2 years after surgery (P>0.05). At 3-month follow-up, all pre-RMUS urethral funneling during Valsalva disappeared in patients without preoperative DO.Comparatively, 50.0% (3/6) urethral funneling still presented in DO patients, who had a lower cure rate (55.6%, 5/9) at the 2-year follow-up. [Conclusion] RMUS can reduce the posterior urethravesical angel at rest and during Valsalva, reduce bladder neck descent distance and the rate of urethral funneling during Valsalva in MUI patients, which can enhance urinary continence.There seems to be a correlation between DO and urethral funneling during Valsalva, while RMUS may potentially reverse the two markers.
