| Objective: To investigate the value of bladder neck mobility measured via transperineal ultrasound in the diagnosis of postpartum stress urinary incontinence(PSUI), study the efficacy of biofeedback combined with electrical stimulation on postpartum pelvic floor dysfunction(PPFD),and investigate factors which effect the treatment outcome of postpartum stress urinary incontinence(PSUI) applying biofeedback conbi-ned with electrical stimulation.Methods :The first part of the study was conducted with 275 women 6 to 8 weeks after childbirth, who were divided into SUI group(n=151) and control group(n=124),each taking a pelvic ultrasound examination to determine the bladder neck-sy-mphysis pubis distance(BSD) at rest and on Valsalva state, then calculate their difference as the mobility of the neck blad-der. In addition, the dignostic veracity was tested via a ROC curve; In the second part,151 patients were divided into treat-ment group and non-treatment group. The treatment group received biofeedback therapy combined with electrical stimulat-tion,and took pelvic floor exercise, while the other group only took pelvic floor exercise. Both groups were fellow-up to observe the efficacy. The third part was conducted on the treatment group. The influences of age, pre-pregnancy body mass index,weight gain during prenancy, mode of delivery,fetal weight,PSUI severity and bladder neck mobility on treatment outcome were analyzed by means of univariate and multivariate analysis.Results 1.The mobility of the neck bladder of SUI group is larger than the control group, the difference was statistically significant. When regarding the bladder neck mobility as diagnostic criteria for PSUI and drawing ROC curve, the area under the curve was 0.901. The cutoff value of 32.5mm has the highest dignostic value, in which case the diagnostic sensitivity was 85.7%, specificity was 90.2%, positive likelihood was 8.7, and negative likelihood ratio was 0.16. Bladder neck mobilities of mild, moderate and severe group are neither different; 2.At three months postpartum, the maximum pelvic muscle contraction pressure of the treatment group and the non-treatment group were 39.97 ± 6.77μV and 37.56 ± 4.33μV respectively, difference between two groups was statistically significant(p <0.05);At six months postpartum, the pelvic muscle maximum contraction pressure of the treatment group and the non-treatment group were 44.94 ± 5.98μV and 43.00 ± 4.23μV respectively, and the continued pelvic muscle contraction pressure were 32.96 ± 5.19μV and 30.14 ± 5.36μV, the bladder neck mobility were 26.38 ± 3.86 mm and 29.16 ± 5.21 mm, and sexual quality scores were 68.21 ± 7.20 and 61.04 ± 8.72,differences of all these measures between two groups were statistically significant(p <0.05); the cure rate, improvement rate and inefficient of treatment group were 50.5%,16.8 %,32.6%,respectively,while those of the control group were 14.3%,35.7% and 50%, respectively. The difference of onstituent ratios of two groups were statistically significant(p <0.05);3. All the patients were followed until 6 months postpartum, and the overall cure rate was 50.5%.Univariate analysis showed that the weight gain during pragancy, bladder neck mobility,mode of delivery and PSUI severity have effect on treatment outcome(p<0.05). While the multivaritive analysis showed that pregnancy ≥17.5kg,SUI severity were dependent factors affecting treatment outcome(p<0.05).Conclusions 1. The bladder neck mobility has high value in the diagnosis and of PSUI.2.Biofeedback combined with electrical stimulation therapy can significantly increase the cure rate of PSUI,promote pelvic floor muscle to recovery after the birth, and help to make mobility become normal. Therefore, it can be applied in postpartum pelvic floor dysfunction.3. The amount of weight gain during pregnancy, and the severity of PSUI are two important factors that influence treatment outcome of PSUI using biofeedback combined with electrical stimulation therapy. |
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