尿动力学诊断女性尿失禁及联合会阴超声评估尿控功能的研究
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摘要
目的:阐明尿动力学检查在临床诊断中的意义,探讨尿动力检查结合经会阴超声检查对女性压力性尿失禁(stress urinary incontinence, SUI)患者膀胱尿道功能的评估价值,并进一步研究TVT-O术后达到控尿的机理。
方法:本研究第一部分选取169例门诊尿失禁患者,通过临床病史采集以及尿动力学检查,分别进行临床症状诊断与尿动力学诊断。本研究第二部分,选取24例SUI患者,于术前、术后1个月和术后3个月分别采用尿动力学检查测量初急(ND)、最大尿流率(Qmas)、最大尿流率时逼尿肌压力(PdetQ)、腹压漏尿点压(ALPP)、尿道全长(UL)、功能性尿道长度(FUL)、控制带长(Z)、控制带/尿道全长(Z/UL)和最大尿道闭合压力(MUCP)等功能参数;并于术前、术后3个月分别在静息状态与Valsalva动作状态下,经会阴超声检测膀胱颈移动度(Mu)、尿道膀胱后角(αr,αs)与尿道角(βr,βs),于术后3个月在静息状态下测量膀胱颈到吊带中点的距离(D)。另设正常对照组15例,检测以上指标。
结果:1、169例尿失禁患者临床症状诊断为MUI的占54%、SUI占28%、UUI占18%;而尿动力学诊断为USUI的占45%、UMUI占21%、DO占16%、NUI占18%。虽然临床症状诊断与尿动力学诊断结果之间是有关的(Χ2=18.94,P = 0.001),但二者存在显著性差异(P < 0.001),且一致性较差(Kappa值=0.16)。2、SUI组术前UI、FUL、Z、Z/UL和MUCP均较对照组显著降低(均P < 0.05)。正常尿道压力曲线呈圆滑对称形,而SUI患者尿道压力曲线变化多样,曲线下面积均下降,尿道闭合功能受损。TVT-O术平均操作时间为17min,症状改善情况好,术中术后并发症少。SUI组术前可诱导出ALPP,而术后均未诱导出。术后ND和PdetQ与术前无明显差异。术后1个月Qmax较术前与术后3个月均显著降低(均P < 0.05);UL、FUL、Z与Z/UL较术前显著增高(均P < 0.05),但与术后3个月间无明显差异;MUCP与术前无显著差异。术后3个月FUL、Z与Z/UL较术前显著增高(均P < 0.05),但与对照组无明显差异;UL与MUCP较术前显著增高,但比对照组显著减低(P < 0.05);Qmax较术前与对照组无明显差异。
3、SUI组术前Mu,αr、αs较术后3个月和对照组均显著增大,而βr、βs显著减小(均P < 0.01);但是术后3个月与对照组间无显著差异。D测得18.23±1.73(mm),D/UL为52.6±2.96(%)。
4、ISD组术前UL、FUL、Z、Z/UL与MUCP较非ISD组显著降低、Qmax显著增高(均P < 0.05)。术后3个月Qmax、UL、FUL、Z和Z/UL与非ISD组均无明显差异;MUCP较非ISD组降低,但是△MUCP两组间无明显差异。而ISD组与非ISD组超声参数之间均无明显差异。
结论:单纯临床症状诊断与尿动力学诊断之间一致性较差,不能准确诊断尿失禁类型。SUI患者尿道基础闭合功能及阻抗应力的作用障碍、膀胱颈和尿道周围的支持组织薄弱,ISD组与非ISD组之间存在膀胱尿道功能差异但无明显的解剖形态学差异。TVT-O术通过提高尿道闭合功能、加强支持组织的作用来恢复正常的解剖位置及形态,进而达到术后控尿作用。因此,尿动力学检查结合经会阴超声检查对SUI的诊断以及TVT-O术后随访等方面具有重要意义。
Objective: To elucidate the significance of urodynamic testing in clinical diagnosis, investigate the role of urodynamic associated with perineal ultrasonography on the the vesicourethral functional evaluation in patients with stress urinary incontinence, and further investigate the mechanism of urinary continence after tension-free vaginal tape obturator (TVT-O) procedure.
Methods: In the first part, 169 female outpatients with urinary incontinence were included, clinical history was collected and urodynamic testing was performed for clinical and urodynamic diagnosis, respectively. In the second part, 24 patients with SUI and 15 controls were underwent Urodynamic test to determine the normal desire to void, maximum void, voided at higher pressure, abdomen leak point pressure, urethral length, functional urethral length, continence zone, continence zone/ urethral length, maximum urethral closure pressure at pre-operation、1 month and 3 months after operation. In addition, at pre-operation and 3 months after operation, perineal ultrasonography was performed for Mu, posterior urethra-vesical angle(αr,αs) and the urethral knee angulation (βr,βs) at rest or during the Valsalva maneuver. Furthermore, the distance between bladder neck and the middle of the tape (D) was also measured at rest at 3 months after operation.
Results: (1) 54% of the 169 urinary incontinent patients are clinically diagnosed as MUI, 28% SUI, and 18% UUI. However, 45% of them are finally diagnosed as USUI, 21% UMUI, 16% DO, and 18% NUI by urodynamic testing. Although the clinical diagnosis is related to urodynamic diagnosis (Χ~2=18.94, P = 0.001), the results exhibit a significant difference (P < 0.001) with a worse consistency (Kappa value is 0.16) between them. (2) FUL, Z, Z/UL and MUCP in SUI group were significantly reduced compared with control (all P < 0.05). In the control, urethral pressure profile showed a slick and symmetric property,however the curves are varied wth a decreased area under curve and an impaired urethral close function in SUI group. The mean operative duration of TVT-O is 17min, with better relief from clinical symptoms and fewer intra- or post-operative complication. ALPP was appeared at pre-operation, but not at post-opration. There were no significant differences in ND and Pdet.Qmax between pre- and post-operation. At 1 month after operation, Qmax was significant decreased compared with pre-operation or 3 months after operation (all P < 0.05), UL, FUL, Z and Z/UL were all increased compared with pre-operation (all P < 0.05), but not significantly different when they were compared with 3 months after operation. While the MUCP did not differ between pre- and 1 month after operation. At 3 month after operation, FUL, Z and Z/UL were persistently increased compared with pre-operation (all P < 0.05), but did not significantly differ from the control. Meanwhile, significantly reduced UL and MUCP compared with the control, and increased UL and MUCP compared with pre-operation were observed. However, by 3 month after operation, there were no difference in Qmax compared with pre-operation or control.
(3) Promimently increased Mu,αr,αs and decreasedβr,βs were found in SUI group before operation compared with 3 months after operation or with control (all P < 0.01). However, no significant differences in them were observed in the comparision of control and SUI group at 3 months after operation. In addition, the distance between bladder neck to the middle of the tape was 18.23±1.73 mm, The D/UL was 52.6±2.96 (%). (4) Compared with non-ISD group, UL、FUL、Z、Z/UL and MUCP were significantly declined and Qmax showed significantly enhanced in ISD group before operation (all P < 0.01). By 3 months after operation, except MUCP which was reduced in ISD group, there were no longer any differences in Qmax, UL, FUL, Z, Z/UL, and the discrepancy before and 3 month after operation of MUCP between these two groups. Likewise, there were no significant differrences in all of the ultrasound parameters between these two groups.
Conclusions: Clinical diagnosis based on clinical history has a bad consistency wth urodynamic diagnosis, thus it can not be used to accurate diagnose urinary incontinence. Patients with SUI exhibit disturbances in static and dynamic urethral closure function, and disorders of weakness in bladder neck and periurethral supporting tissue. There were significant differences in vesicourethral function but not in anatomic morphological changes between ISD and non-ISD groups. TVT-O procedure exerts its actions on urinary continence through the recovery of normal anatomic position and morphous attributed to improved urethral closure function and enhanced supporting tissue. Therefore, urodynamic testing associated with perineal sonography may play an important role in the diagnosis of SUI and the follow-up visit after TVT-O procedure.
方法:本研究第一部分选取169例门诊尿失禁患者,通过临床病史采集以及尿动力学检查,分别进行临床症状诊断与尿动力学诊断。本研究第二部分,选取24例SUI患者,于术前、术后1个月和术后3个月分别采用尿动力学检查测量初急(ND)、最大尿流率(Qmas)、最大尿流率时逼尿肌压力(PdetQ)、腹压漏尿点压(ALPP)、尿道全长(UL)、功能性尿道长度(FUL)、控制带长(Z)、控制带/尿道全长(Z/UL)和最大尿道闭合压力(MUCP)等功能参数;并于术前、术后3个月分别在静息状态与Valsalva动作状态下,经会阴超声检测膀胱颈移动度(Mu)、尿道膀胱后角(αr,αs)与尿道角(βr,βs),于术后3个月在静息状态下测量膀胱颈到吊带中点的距离(D)。另设正常对照组15例,检测以上指标。
结果:1、169例尿失禁患者临床症状诊断为MUI的占54%、SUI占28%、UUI占18%;而尿动力学诊断为USUI的占45%、UMUI占21%、DO占16%、NUI占18%。虽然临床症状诊断与尿动力学诊断结果之间是有关的(Χ2=18.94,P = 0.001),但二者存在显著性差异(P < 0.001),且一致性较差(Kappa值=0.16)。2、SUI组术前UI、FUL、Z、Z/UL和MUCP均较对照组显著降低(均P < 0.05)。正常尿道压力曲线呈圆滑对称形,而SUI患者尿道压力曲线变化多样,曲线下面积均下降,尿道闭合功能受损。TVT-O术平均操作时间为17min,症状改善情况好,术中术后并发症少。SUI组术前可诱导出ALPP,而术后均未诱导出。术后ND和PdetQ与术前无明显差异。术后1个月Qmax较术前与术后3个月均显著降低(均P < 0.05);UL、FUL、Z与Z/UL较术前显著增高(均P < 0.05),但与术后3个月间无明显差异;MUCP与术前无显著差异。术后3个月FUL、Z与Z/UL较术前显著增高(均P < 0.05),但与对照组无明显差异;UL与MUCP较术前显著增高,但比对照组显著减低(P < 0.05);Qmax较术前与对照组无明显差异。
3、SUI组术前Mu,αr、αs较术后3个月和对照组均显著增大,而βr、βs显著减小(均P < 0.01);但是术后3个月与对照组间无显著差异。D测得18.23±1.73(mm),D/UL为52.6±2.96(%)。
4、ISD组术前UL、FUL、Z、Z/UL与MUCP较非ISD组显著降低、Qmax显著增高(均P < 0.05)。术后3个月Qmax、UL、FUL、Z和Z/UL与非ISD组均无明显差异;MUCP较非ISD组降低,但是△MUCP两组间无明显差异。而ISD组与非ISD组超声参数之间均无明显差异。
结论:单纯临床症状诊断与尿动力学诊断之间一致性较差,不能准确诊断尿失禁类型。SUI患者尿道基础闭合功能及阻抗应力的作用障碍、膀胱颈和尿道周围的支持组织薄弱,ISD组与非ISD组之间存在膀胱尿道功能差异但无明显的解剖形态学差异。TVT-O术通过提高尿道闭合功能、加强支持组织的作用来恢复正常的解剖位置及形态,进而达到术后控尿作用。因此,尿动力学检查结合经会阴超声检查对SUI的诊断以及TVT-O术后随访等方面具有重要意义。
Objective: To elucidate the significance of urodynamic testing in clinical diagnosis, investigate the role of urodynamic associated with perineal ultrasonography on the the vesicourethral functional evaluation in patients with stress urinary incontinence, and further investigate the mechanism of urinary continence after tension-free vaginal tape obturator (TVT-O) procedure.
Methods: In the first part, 169 female outpatients with urinary incontinence were included, clinical history was collected and urodynamic testing was performed for clinical and urodynamic diagnosis, respectively. In the second part, 24 patients with SUI and 15 controls were underwent Urodynamic test to determine the normal desire to void, maximum void, voided at higher pressure, abdomen leak point pressure, urethral length, functional urethral length, continence zone, continence zone/ urethral length, maximum urethral closure pressure at pre-operation、1 month and 3 months after operation. In addition, at pre-operation and 3 months after operation, perineal ultrasonography was performed for Mu, posterior urethra-vesical angle(αr,αs) and the urethral knee angulation (βr,βs) at rest or during the Valsalva maneuver. Furthermore, the distance between bladder neck and the middle of the tape (D) was also measured at rest at 3 months after operation.
Results: (1) 54% of the 169 urinary incontinent patients are clinically diagnosed as MUI, 28% SUI, and 18% UUI. However, 45% of them are finally diagnosed as USUI, 21% UMUI, 16% DO, and 18% NUI by urodynamic testing. Although the clinical diagnosis is related to urodynamic diagnosis (Χ~2=18.94, P = 0.001), the results exhibit a significant difference (P < 0.001) with a worse consistency (Kappa value is 0.16) between them. (2) FUL, Z, Z/UL and MUCP in SUI group were significantly reduced compared with control (all P < 0.05). In the control, urethral pressure profile showed a slick and symmetric property,however the curves are varied wth a decreased area under curve and an impaired urethral close function in SUI group. The mean operative duration of TVT-O is 17min, with better relief from clinical symptoms and fewer intra- or post-operative complication. ALPP was appeared at pre-operation, but not at post-opration. There were no significant differences in ND and Pdet.Qmax between pre- and post-operation. At 1 month after operation, Qmax was significant decreased compared with pre-operation or 3 months after operation (all P < 0.05), UL, FUL, Z and Z/UL were all increased compared with pre-operation (all P < 0.05), but not significantly different when they were compared with 3 months after operation. While the MUCP did not differ between pre- and 1 month after operation. At 3 month after operation, FUL, Z and Z/UL were persistently increased compared with pre-operation (all P < 0.05), but did not significantly differ from the control. Meanwhile, significantly reduced UL and MUCP compared with the control, and increased UL and MUCP compared with pre-operation were observed. However, by 3 month after operation, there were no difference in Qmax compared with pre-operation or control.
(3) Promimently increased Mu,αr,αs and decreasedβr,βs were found in SUI group before operation compared with 3 months after operation or with control (all P < 0.01). However, no significant differences in them were observed in the comparision of control and SUI group at 3 months after operation. In addition, the distance between bladder neck to the middle of the tape was 18.23±1.73 mm, The D/UL was 52.6±2.96 (%). (4) Compared with non-ISD group, UL、FUL、Z、Z/UL and MUCP were significantly declined and Qmax showed significantly enhanced in ISD group before operation (all P < 0.01). By 3 months after operation, except MUCP which was reduced in ISD group, there were no longer any differences in Qmax, UL, FUL, Z, Z/UL, and the discrepancy before and 3 month after operation of MUCP between these two groups. Likewise, there were no significant differrences in all of the ultrasound parameters between these two groups.
Conclusions: Clinical diagnosis based on clinical history has a bad consistency wth urodynamic diagnosis, thus it can not be used to accurate diagnose urinary incontinence. Patients with SUI exhibit disturbances in static and dynamic urethral closure function, and disorders of weakness in bladder neck and periurethral supporting tissue. There were significant differences in vesicourethral function but not in anatomic morphological changes between ISD and non-ISD groups. TVT-O procedure exerts its actions on urinary continence through the recovery of normal anatomic position and morphous attributed to improved urethral closure function and enhanced supporting tissue. Therefore, urodynamic testing associated with perineal sonography may play an important role in the diagnosis of SUI and the follow-up visit after TVT-O procedure.
引文
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48 张勇,夏小芳,徐刚等, 女性真性压力性尿失禁尿动力学分析. 现代实用医学,2005; 17(8):462-463.
49. Fleischmann N, Flisser AJ, Blaivas JG, et al. Sphincteric urinary incontinence: relationship of vesical leak point pressures, urethral mobility and severity of incontinence. J Urol, 2003; 169: 999-1002.
50、Brown JS. Grady D. Ouslander JG et al. Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet Gynecol, 1999; 94(1):66-70.
51 Pregazzi R, Sartore A, Bortoli P, et al. Ultrasonographic assessment of urethrovesicalmobility in women. Arch ItalUrol Androl, 2000; 72 (4) : 335-339.
52 Pregazzi R, Sartore A,Bortoli P, et al. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG, 2002; 109(7) : 821-827.
53 Huang WC, Yang JM. Bladder neck funneling on ultrasound in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology, 2003; 61(5): 936-941.
54 DeLancey JOL. Correlative study of pararethral anatomy. Obstet Gynecol 1986; 68: 91-97.
55 Kobata SA, Gir?o MJ, Sartori MG, et al. Urodynamic and ultrasonographic evaluation after continence surgery. Pelvic Floor Dysfunct, 1999; 10(5): 321-324.
56 Renaud T, Xevier D, Stephane D, Aurelia CL, et al. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Obstet Gynecol, 2004; 190:602–608.
57 Kuo HC. Anatomical and functional results of pubovaginal sling procedure using polypropylene mesh for the reestment of stress urinary incontinence. Urol, 2001; 166(1): 152-157.
58 Lo TS, Wang AC, Horng SG,ea tl. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet GynecolScand, 2001; 80(1): 65-70.
59 Schuettoff S, Beyersdorff D, Gauruder-Burmester A, ea tl. Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo. Ultrasound Obstet Gynecol, 2006; 27(6): 687-92.
60 Tunn R, Gauruder-Burmester A, K¨ olle D. Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain. Ultrasound Obstet Gynecol 2004; 23: 298–301.
61. Kuuva N and Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand, 2002; 81: 72–77.
62 Chene G, Cotte B, Tardieu AS, Savary D, ea tl. Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O). Pelvic Floor Dysfunct, 2008; Mar 29[Epub ahead of print].
63 Jacek Kociszewski, Oliver Rautenberg, Daniele Perucchini, ea tl. Tape Functionality: Sonographic Tape Characteristicsand Outcome After TVT Incontinence Surgery. Neurourology and Urodynamics, 2008 ; Feb 20. [Epub ahead of print]
64 、胡兵,应涛,陈磊等 超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究 中国超声医学杂志,2001;17(1):20-23.
1.Volkner BG , Nesslaner T,Rinnal L, et al. Sursical intervention for complications of tension-free tape procedure.J Urol, 2003; 69: 570-574
2.Heit M ,Culligan P ,Rosenquist C ,et al. Is pelvic organ prolapse acause of pelvic or low back pain. Obstet Gynecol, 2002; 99: 23-28.
3.FitzGerald MP, Brubaker L. Urinary incontinence symptom scores and urodynamic diagnoses. Neurourol Urodyn, 2002; 21:30-35.
4.Bader W,Tunn R,Viereek V,et a1.Intmital and pefineal sonography in diagnosing stress urinary incontinence · possible clinical applications.Ultrasehall Med, 2004; 25(3):181-190
5.Viereck V,Pauer HU,Bader W ,et a1.Ulasound imaging of the lower urinarytract in women before an d after colposuspension:a 6-mollth follow-up.UltraschaU Med, 2003; 24(5):340-344.
6、李为兵,鄢俊安,宋波等 三种膀胱颈悬吊术治疗真性压力性尿失禁对照分析 第三军医大学学报, 2003; 25(9):802-805.
7.Kilicarslan H , Gokce G, Ayan S ,ea tl . Predictors of outcome after in situanterior vaginal wall sling surgery. Int Urogynecol J Pelvic Floor Dysfunct , 2003; 14(5) : 339 - 341.
8.Lo TS, Wang AC, Horng SG,ea tl. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand, 2001; 80(1): 65-70.
9.Ouslander J ,Staskin D ,Raz S ,et al. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. Urol ,1987; 137-168.
10.Jensen JK ,Nielsen FR,Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol. 1994; 83: 904-910.
11. Rezapour M, Falconer C, Ulmsten U.ea tl. Tension-Free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)--a long-term follow-up. Pelvic Floor Dysfunct, 2001; 12 Suppl 2: S12-14.
12、李映川 丁强 方祖军等. TVT术对尿道固有括约肌功能缺陷的女性压力性尿失禁患者的临床观察.临床泌尿外科杂志,2005;20(11): 654-657.
13.Koelbl H,Bemasehek G,Deufinger J.Assessment of female urinary incontinence by introital sonography.J Clin Ultrasound, 1990; 18(4):370-374.
14.Chen GD,Su TH ,Lin LY.Applicability of perineal sonography in anatomica1 evaluation of bladder neck in women with and without genuine stress incontinence.J Clin Ultrasound, 1997; 25:189-194.
15.Sendag F,Vidinli H,Kazan di M,et a1.Role ofpefineal sonography in the evaluation of patients with stress urinary incontinenee.Aust N Z J Ohstet Gynaeeol,2003; 43(1):54·57.
16.Mouritscn L.Rasmussen A.B1adder neck mobility evaluated by vaginal ultrasongraphy.Br J Urol, 1993; 71(2):166-171.
17.Masata J,Marran A,Svabik K,et a1.Changes in urethra mobility after TVT operation.Ceska Gynekol, 2005; 70(3):220-225.
18.Yalcin OT,Hassa H,Or.alp S.Efectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence.Acta Obstet Gynecol Scand, 2000; 79(5):421·426.
19.Pregazzi R, Sartore A,Bortoli P, et al. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG, 2002; 109(7) : 821-827.
20.Omer TY,Hassa H ,Ozalp S.Effectiveness of u1trasonographic parameters for documenting the severity of anatomic stress incontinence.Acta 0bstet Gyneco1 Scand, 200; 79:421-426.
21.Granados-Loarca EA,Alcahe VR,de-Leon-Lopez H,et a1.The usefulness of perineal ultrasound in urinary incontinence in women. Arch Esp Uro1,1999,52:778-782.
22.Skala C,Emons G,Krauss T,et a1.Postoperative funneling after antiincontinence surgery--a prognostic indicator? Part1:colposuspension.Neurourol Urudyn, 2004; 23(7):636-642.
23.Athanasiou S, Khullar V, Boos K, etal. Imaging the urethral sphincter with three-dimensional ultrasound.Obstet Gynecol, 1999; 94(2):295-301.
2 Paul Abrams,Linda Cardozo,Magnus Fall,et al.The Standardisation of Terminology of Lower Urinary Tract Function:Peport from the Standardisation Sub-committee of the International Continence Society. Neurourology and Urodynamics, 2002; 21: 167-178.
3 Butler RN, Maby JI, Montella JM, et al. Urinary incontinence: key to diagnosis of the older women.Geriatrics, 1999; 50(11): 22-30.
4 宋岩峰 李亚钦 许波等. 福州市社区女性尿失禁发病现状的分析. 中华妇产科杂志, 2004;39(4):257-259.
5 王建六,曹冬,张晓红等 北京郊区女性尿失禁及盆腔脏器脱垂发病情况及其对生活质量影响的抽样调查 中华妇产科杂志, 2007;8(1):5-9.
6 叶明 唐家龄 邱秀等 广州地区成年女性尿失禁发病率及其相关影响因素 中国临床康复,2004;8(27): 5806-5808.
7 Wilson L, Brown JS, Shin GP. et al. Annual direct cost of urinary incontinence. Obstet Gynecol, 2001; 98(3): 398-406.
8 Petri E, Koelbl H, Schaer G.. What is the place of ultrasound in urogynecology? A written panel. Int Urogynecol J Pelvic Floor Dysfunct, 1999; 10(4): 262-273.
9 Schaer GN, Perucchini D, Munz E, et al.Sonographic evaluation of the bladder neck in continence and stress-incontinent women. Obstet Gynecol, 1999; 93(3): 412-416.
10 Klingele CJ, CarleyME, Hill RC,et al.. Patient characteristics that are associated with urodynamically diagnosed detrusor instability and genuine stress incontinence. AmJ Obstet Gynecol, 2002; 186: 866-868.
11. Enhorning G. Simultaneous recording of intravesical and intra-urethral pressure. A study on urethral closure in normal and stress incontinent women. Acta Chir Scand Suppl. 1961; Suppl 276: 1-68.
12 DeLancey JO. Structural support of the uretha as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obset Gynecol, 1994; 170(6): 1713-1723.
13 Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990; 153: 7-31.
14 Ulmsten U, Henriksson L, Johnson P, et al. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 1996; 7(2):81-85.
15 De Leval J.Novel surgical technique for the treatment of female stress urinary incontinence:transobturator vaginal tape inside.out.Eur Urol,2003; 44(6):724-730.
16 Zullo MA, Plotti F, Calcagno M, et a1. One-year follow-up of tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of female stress urinary incontinence: a prospective randomised trial. Eur Urol.,2007; 51(5): 1376-1382.
17 Tayrac R, Deleux X, Droupy S, et al. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 2004; 190: 602-608.
18 Bonnet P, Waltregny D, Reul O, et al. Transobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations. J Urol. 2005; 173(4): 1223-1228.
19 Bader W, Tunn R, Viereck V,et al. Introital and perineal sonography in diagnosing stress urinary incontinence-possible clinical applications. Ultraschall Med, 2004; 25(3): 181-190.
20 Jensen JK, Nielsen FR, OstergardDR, et al. The role of patient history in the diagnosis of urinary incontinence.Obstet Gynecol, 1994; 83: 904-910.
21 Jack B, Alexander V, Corey O, et al. Are there differences between women with urge predominant and stress predominant mixed urinary incontinence.Neurourology and Urodynamics, 2007; 26: 204-207.
22 Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in theUnited States. World J Urol, 2003; 20: 327-336.
23 Sandvik H, Hunskaar S, Vanvik A, et al. Diagnostic classiffication of female urinary incontinence: An epidemiological survey corrected for validity. J Clin Epidemiol, 1995; 48: 339-343.
24 Boot C and Pascoe D. Inroduction to urinary incontinence. Hospital Pharmacist. 2002; 9: 65-68.
25 Khan MS, Chaliha C, Leskova L, et al. The relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration. BJOG, 2004; 111(5): 468-474.
26 FitzGerald MP, Brubaker L. Urinary incontinence symptomscores and urodynamic diagnoses. Neurourol Urodyn 2002; 21:30-35.
27 Arnold EP ,Webster JR ,Loose H ,et al. Urodynamics of female incontinence. Obstet Gynecol, 1973; 117∶805.
28 Ouslander J ,Staskin D ,Raz S ,et al. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. Urol ,1987; 137∶ 68.
29 Nager CW, Albo ME, Fitzgerald MP, et al. Urodynamic values for stress incontinent women. Neurourol Urodyn. 2007;26(3):333-340.
30 Chaliha C and Khullar V. Mixed incontinence. Urology 2004; 63:51–57.
31 Bump R, Norton P, Zinner N, et al. Mixed urinary incontinence symptoms: Urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol, 2003; 102:76–83.
32 Jung SY, Fraser MO, Ozawa H, et al. Urethral afferent nerve activity affects the micturition reflex: Implication for the relationship between stress incontinence and detrusor instability. J Urol 1999; 162: 204–212.
33 Fulford SC, Flynn R, Barrington J, et al. An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. J Urol, 1999; 162: 135–137.
34 Chaikin DC, Rosenthal J, Blaivas JG. Pubovaginal fascial sling for all types ofstress urinary incontinence: Long-term analysis. J Urol, 1998; 160: 1312–1316.
35 Trockman BA, Leach GE, Hamilton J, et al. Modified Pereyra bladder neck suspension: 10-Yearmean followup using outcomes analysis in 125 patients. J Urol 1995; 154: 1841–1847.
36 Karram MM, Bhatia NN. Management of coexistent stress and urge urinary incontinence. Obstet Gynecol, 1989; 73: 4–7.
37 Kulseng-Hanssen S, Husby H, et al. Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. Urogynecol J Pelvic Floor Dysfunct, 2008; 19(3): 391-396.
38 Lagro-Janssen AM, Debruyne FL, Van Weel C. Value of the patinent’s case history in diagnosing urinary incontience in general practice. 1991; Urol 67: 569-572.
39 Klingele CJ, Carley ME, Hill RC. Patient Characteristics that are associated with urodynamically diagnosed detrusor instability and genuine stress incontinence. 2002; 186: 866-868.
40 Mary P, Linda B. Urinary incontinence synptom scores and urodynamic diagnoses.Neurourology and Urodynamics, 2002; 21: 30-35.
41 Cardoza L ,Stanton SL. Genuine stress incontinence and detrusor instability :a clinical and urodynamic review of 200 cases. Obstet Gynecol ,1980; 87∶184.
42 Jensen JK ,Nielsen FR,Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol. 1994; 83: 904-10.
43 文建国. 尿动力学检查在女性尿失禁诊断中的应用. 中华妇产科杂志,2004; 39(10):717-719.
44 Volkner BG, Nesslaner T, Rinnab L, et al. Surgical intervention for complications of tension-free vaginal tape procedure. J Urol, 2003; 169: 570-574.
45 Dugan E, Cohen SJ, Bland DR, et al. The association of depressive symptoms and urinary incontinence among older adults. J Am Geriatr Soc, 2000; 48(4): 413-416.
46 Hann-Chorng Kuo. The Relationships of Urethral and Pelvic Floor Muscles and the Urethral Pressure Measurements in Women with Stress Urinary Incontinence Eur Urol. 2000; 37(2):149-55.
47 DahmS E , LampelD S , Kloeppel S , et al . Low urethral pressure profile-clinical implications[J].Scand J Urol Neohrol Suppl,2001; (207):100-105.
48 张勇,夏小芳,徐刚等, 女性真性压力性尿失禁尿动力学分析. 现代实用医学,2005; 17(8):462-463.
49. Fleischmann N, Flisser AJ, Blaivas JG, et al. Sphincteric urinary incontinence: relationship of vesical leak point pressures, urethral mobility and severity of incontinence. J Urol, 2003; 169: 999-1002.
50、Brown JS. Grady D. Ouslander JG et al. Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet Gynecol, 1999; 94(1):66-70.
51 Pregazzi R, Sartore A, Bortoli P, et al. Ultrasonographic assessment of urethrovesicalmobility in women. Arch ItalUrol Androl, 2000; 72 (4) : 335-339.
52 Pregazzi R, Sartore A,Bortoli P, et al. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG, 2002; 109(7) : 821-827.
53 Huang WC, Yang JM. Bladder neck funneling on ultrasound in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology, 2003; 61(5): 936-941.
54 DeLancey JOL. Correlative study of pararethral anatomy. Obstet Gynecol 1986; 68: 91-97.
55 Kobata SA, Gir?o MJ, Sartori MG, et al. Urodynamic and ultrasonographic evaluation after continence surgery. Pelvic Floor Dysfunct, 1999; 10(5): 321-324.
56 Renaud T, Xevier D, Stephane D, Aurelia CL, et al. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Obstet Gynecol, 2004; 190:602–608.
57 Kuo HC. Anatomical and functional results of pubovaginal sling procedure using polypropylene mesh for the reestment of stress urinary incontinence. Urol, 2001; 166(1): 152-157.
58 Lo TS, Wang AC, Horng SG,ea tl. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet GynecolScand, 2001; 80(1): 65-70.
59 Schuettoff S, Beyersdorff D, Gauruder-Burmester A, ea tl. Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo. Ultrasound Obstet Gynecol, 2006; 27(6): 687-92.
60 Tunn R, Gauruder-Burmester A, K¨ olle D. Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain. Ultrasound Obstet Gynecol 2004; 23: 298–301.
61. Kuuva N and Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand, 2002; 81: 72–77.
62 Chene G, Cotte B, Tardieu AS, Savary D, ea tl. Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O). Pelvic Floor Dysfunct, 2008; Mar 29[Epub ahead of print].
63 Jacek Kociszewski, Oliver Rautenberg, Daniele Perucchini, ea tl. Tape Functionality: Sonographic Tape Characteristicsand Outcome After TVT Incontinence Surgery. Neurourology and Urodynamics, 2008 ; Feb 20. [Epub ahead of print]
64 、胡兵,应涛,陈磊等 超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究 中国超声医学杂志,2001;17(1):20-23.
1.Volkner BG , Nesslaner T,Rinnal L, et al. Sursical intervention for complications of tension-free tape procedure.J Urol, 2003; 69: 570-574
2.Heit M ,Culligan P ,Rosenquist C ,et al. Is pelvic organ prolapse acause of pelvic or low back pain. Obstet Gynecol, 2002; 99: 23-28.
3.FitzGerald MP, Brubaker L. Urinary incontinence symptom scores and urodynamic diagnoses. Neurourol Urodyn, 2002; 21:30-35.
4.Bader W,Tunn R,Viereek V,et a1.Intmital and pefineal sonography in diagnosing stress urinary incontinence · possible clinical applications.Ultrasehall Med, 2004; 25(3):181-190
5.Viereck V,Pauer HU,Bader W ,et a1.Ulasound imaging of the lower urinarytract in women before an d after colposuspension:a 6-mollth follow-up.UltraschaU Med, 2003; 24(5):340-344.
6、李为兵,鄢俊安,宋波等 三种膀胱颈悬吊术治疗真性压力性尿失禁对照分析 第三军医大学学报, 2003; 25(9):802-805.
7.Kilicarslan H , Gokce G, Ayan S ,ea tl . Predictors of outcome after in situanterior vaginal wall sling surgery. Int Urogynecol J Pelvic Floor Dysfunct , 2003; 14(5) : 339 - 341.
8.Lo TS, Wang AC, Horng SG,ea tl. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand, 2001; 80(1): 65-70.
9.Ouslander J ,Staskin D ,Raz S ,et al. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. Urol ,1987; 137-168.
10.Jensen JK ,Nielsen FR,Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol. 1994; 83: 904-910.
11. Rezapour M, Falconer C, Ulmsten U.ea tl. Tension-Free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)--a long-term follow-up. Pelvic Floor Dysfunct, 2001; 12 Suppl 2: S12-14.
12、李映川 丁强 方祖军等. TVT术对尿道固有括约肌功能缺陷的女性压力性尿失禁患者的临床观察.临床泌尿外科杂志,2005;20(11): 654-657.
13.Koelbl H,Bemasehek G,Deufinger J.Assessment of female urinary incontinence by introital sonography.J Clin Ultrasound, 1990; 18(4):370-374.
14.Chen GD,Su TH ,Lin LY.Applicability of perineal sonography in anatomica1 evaluation of bladder neck in women with and without genuine stress incontinence.J Clin Ultrasound, 1997; 25:189-194.
15.Sendag F,Vidinli H,Kazan di M,et a1.Role ofpefineal sonography in the evaluation of patients with stress urinary incontinenee.Aust N Z J Ohstet Gynaeeol,2003; 43(1):54·57.
16.Mouritscn L.Rasmussen A.B1adder neck mobility evaluated by vaginal ultrasongraphy.Br J Urol, 1993; 71(2):166-171.
17.Masata J,Marran A,Svabik K,et a1.Changes in urethra mobility after TVT operation.Ceska Gynekol, 2005; 70(3):220-225.
18.Yalcin OT,Hassa H,Or.alp S.Efectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence.Acta Obstet Gynecol Scand, 2000; 79(5):421·426.
19.Pregazzi R, Sartore A,Bortoli P, et al. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG, 2002; 109(7) : 821-827.
20.Omer TY,Hassa H ,Ozalp S.Effectiveness of u1trasonographic parameters for documenting the severity of anatomic stress incontinence.Acta 0bstet Gyneco1 Scand, 200; 79:421-426.
21.Granados-Loarca EA,Alcahe VR,de-Leon-Lopez H,et a1.The usefulness of perineal ultrasound in urinary incontinence in women. Arch Esp Uro1,1999,52:778-782.
22.Skala C,Emons G,Krauss T,et a1.Postoperative funneling after antiincontinence surgery--a prognostic indicator? Part1:colposuspension.Neurourol Urudyn, 2004; 23(7):636-642.
23.Athanasiou S, Khullar V, Boos K, etal. Imaging the urethral sphincter with three-dimensional ultrasound.Obstet Gynecol, 1999; 94(2):295-301.
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