Observations On The Pelvic Floor Of Patients With Stress Urinary Incontinence And Underwent TVT-O Surgery Using Three-dimensional Ultrasound

[Objective]This study was designed:1) to compare differences in the neck of bladder, urethra,the levator hiatus and pubovisceral muscle at rest,on Valsalva and contraction between patients with SUI and the healthy female volunteers;2) to compare differences in the neck of bladder,urethra,the levator hiatus and pubovisceral muscle before and after TVT-O procedure;3) to observe the mobility of slings used in TVT-O procedure on Valsalva and contraction.[Menthods]1.The primary part:Observations of the pelvic floor of the female with and without SUI67 women were enrolled including 35 healthy volunteers and 32 patients with SUI,the pelvic floor was scanned using three dimension transperineal ultrasound at rest,on Valsalva and contraction.We measured the distance between the neck of bladder and the inferior edge of the pubic system,the length of the urethra,the angle of the urethra,et al in the sagittal plane and the thickness of the pubovisceral muscle,dimensions of the levator hiatus in the cross section and compared the parameters between the volunteers and patients with SUI.2.The second part:Assessment of the pelvic floor before and after TVT-O procedure.30 patients with SUI cured successfully by TVT-O participated in this study.They underwent transperineal 3D ultrasound twice before TVT-O procedure and 3 months later.We measured the distance between the neck of bladder and the inferior edge of the pubic system,the length of the urethra,the angle of the urethra et al in the sagittal plane and the thickness of the pubovisceral muscle,dimensions of the levator hiatus in the cross section and compared the parameters before and after TVT-O procedure.3.The third part:correlation between the position and mobility of the tape and the effectiveness and complication of TVT-O procedure.34 patients with SUI underwent TVT-O participated in this study.We scanned the pelvic floor at rest,on Valsalva and contration.We measured the distance between the middle of the tape and the inferior edge of the pubic system,the length of the urethra,the length of the urethra between the neck of bladder and the proximate tape,the width of the tape in the sagittal plane and the angle of the tape in the cross section.We identified the differences of the tape on Valsalva and contraction. [Results]1,The primary part:Observation of the pelvic floor of the female with and without SUIComparisons of the distances between the neck of bladder and the inferior edge of the pubic system were significant difference at rest,on Valsalva and contraction,p<0.05;the length of the proximate urethra,the distance between the knee of the urethra and X axis,the thickness of the pubovisceral muscle and the angle of the urethra were significant difference on Valsalva manuever,p<0.05;But on contraction,just the distance between the knee of the urethra and X axis,the thickness of the pubovisceral muscle and the anteroposterior diameter of the levator hiatus were significant difference, p<0.05.others were not significant difference.2,The second part:Assessment of the pelvic floor before and after TVT-O procedure.Before and after TVT-O procedure,comparisons of the neck of bladder and the levator hiatus were not significant difference at rest,on Valsalva and contraction,p>0.05;but the length of the urethra was longer than that after TVT-O surgery at rest and on Valsalva,and the distance between the knee of the urethra and X axis was shorter than before,p<0.05.4.The third part:correlation between the position and mobility of the tape and the effectiveness and complication of TVT-O procedure.The tape used in TVT-O procedure located in the 50%-60%length of the distant urethra,the position and mobility of the tape changed a little on Valsalva and contraction and parameters were not siganificant difference, p>0.05.[Conclusions]1.The transperineal three dimension ultrasound technic is helpful to preoperative evaluation of patients with SUI,observation of the tape,postoperative follow up and analysis of complications.2.Abnormal activities of the neck of bladder and urethra induced by the defect of the supporting structure is one of the important pathogenesisof SUI.3.TVT-O surgery is effective to SUI,but the curative effect is close to the location of the tape and the tension raising intra-abdominal pressure.