Ultrasound Study And Therapy Of The Female Stress Urinary Incontinence

Objective: Urinary incontinence(UI) is comman disease for women. Internation Continence Society (ICS) defined it as"constitute a social and health problem, and can be confirmed on involuntary urine outflow". According to the estimation, more than tens of milllions of women have suffered from urinary incontinence in the world.With the aging of the population, UI has been listed as one of the world's top five disease. Of the female urinary incontinence patients, the vast majority is the stress urinary incontinence, its incidence rate is about 40%. ICS clearly defined:"the urethra involuntary incontinence occurs when increasing the abdominal pressure called stress urinary incontinence(SUI)."The major causes of SUI, first, because of childbirth, birth trauma caused bladder neck and urethra support structure damage, connective tissue around the urethra injury and relax; second, the elastic of connective tissue decreases, urethral sphincter defects or trauma, resulting the urethra can not turn off normally.Ultrasound imaging, shows the shape of the bladder neck and symphysis pubis, the bladder and urethra posterior horn size, observes that the increase in abdominal pressure and the dynamic changes when voiding, such as bladder neck descents, vesicourethral angle increases, with or without bladder prolapse and residual urine. Ultrasound provide a reliable basis for the anatomy change of bladder and urethra, and has the advantages of non-radiative,real-time,convenient,economic. Ultrasound has been an important means for diagnosis, evaluation of the surgical and non-surgical treatment of SUI abroad.Mild stress urinary incontinence patients can accept the conservative treatment, such as drugs,pelvic floor muscle exercise,biofeedback-electrical stimulation. Patients who suffered from moderate to severe stress urinary incontinence or conservative treatment fails, should accept surgical treatment, to improve the quality of life. At present, the suspension of the middle urethra is the major surgery, and the procedure is becoming the first-line treatment of female stress urinary incontinence. Tension-free vaginal tape-obturator(TVT-O) has been recongnized, because of its safty,efficient,and convenience. The purpose of this study, to evaluat the diagnosis and treatment for female urinary incontinence by ultrasonography, to study the indications and complications of the conservative and surgical treatment.Clinical materials:Select 34 female patients presented stress leakage as complaint at the gynecology outpatient in the first hospital of shijiazhuang during February , 2007 to October, 2008. All the patients were maternal, and confirmed as stress urinary incontinence, the mean age was 52.82±9.18years, body mass index (BMI)was 27.01±3.14,mean pregnancy was 2.59 ±0.78,mean childbirth was 1.62±0.65,one patient had diabetes, two cases with high blood pressure, one case with chronic bronchitis, two patients underwent hysterectomy because of uterine myoma. Control group had 30 patients, were also maternal, the mean age was 50.47±8.29,BMI was 27.21±3.54,mean pregnancy was 2.53±1.01 , mean childbirth was 1.50±0.73.All the patients were without pelvic organ prolapse.Methods: 1. SUI group had urine routine examination to exclude urinary tract infection, residual urine was less than 50ml, maximum bladder capacity more than 300ml, cough-leak experiment and marshall-bonney testing were positive. Urodynamic examination exclude unstable bladder. 2. SUI group had 34 patients, control group had 30 patients, 23 cases of SUI patients with bladder filling underwent perineal ultrasonography before and after the operation, measured the distance of bladder neck mobility,posterior urethra-vesical angle and urethral angle. 3. 23cases of patients with SUI underwent the largest bladder capacity and residual urine volume determination. 4. 23 cases underwent TVT-O,11 cases accepted conservative treatment, that is oral midodrine hydrochloride ,at the time, did the pelvic floor muscle exercise.Results: SUI group had the greater distance of bladder neck mobility and posterior urethra-vesical angle than contor group, but the urethral angle was smaller than control group. The distance of bladder neck mobility, posterior urethra-vesical angle and urethral angle were significantly different before and after the operation, but there was no significant difference between the postoperative and the control group. There was no significant difference in the largest bladder capacity and residual urine volume before and after the operation. The operation group had the significantly higher cure rate than the conservative group.Conclusions: 1.The hypermobility of the urethra is one of the causes of SUI. 2.Ultrasound plays an important role in the diganosis and evaluation of the surgery. 3.TVT-O surgery is safe, fast and has a high cure rate, major comlication is groin pain, but can disappear within two weeks, and does not affect the storage of urine and urinary function.