| ObjectiveUnderstanding the change of pelvic organization of patients who have occult stress urinary incontinence objectively,evaluating the application and value of transperineal ultrasound and POP-Q grading system in occult stress urinary incontinence patients,then providing new thought and scheme for preoperative assessment of patients who have severe pelvic organ prolapse with occult stress urinary incontinence by testing the related parameters of the lower urinary tract,bladder neck and anal levator of patients who have severe pelvic organ prolapse with occult stress urinary incontinence and simple severe pelvic organ prolapse through transperineal ultrasound combine with correlation analysis of preoperative POP-Q grading system.Materials and methods 1 Study object79 patients from the third affiliated hospital of Zhengzhou university with severe pelvic organ prolapse(POP)from September 2014 to June 2016,according to urodynamic study whether consolidate with stress urinary incontinence,were merging into pelvic organ prolapse(POP)combine with occult stress urinary incontinence(OSUI)group and simple pelvic organ prolapse(POP)group.Recording preoperative pelvic organ prolapse quantitative index(POP-Q)score,age,gravidity and parity history and other relevant information.2 Ultrasonic parameter analysisMeasured the urethral opening form,urethral inclined angle(UIA),vertical distance of bladder neck and public symphysis(BN-S),levator hiatus area(LHA)in quiescent condition and valsalva condition through transperineum ultrasound,calculating urethral rotation angel(URA),bladder neck movement distance(BND).All data entry EXCEL spreadsheet.Using SPSS21.0 statistical software processing data,then comparing the differences of POP-Q ratings and ultrasound various parameters between two groups of patients.3 Statistical analysisAll the data was processed by SPSS21.0 statistical software.Measurement data using X±s standard,count data described by the quantity and ratio,abnormal distribution measurement data using range interquartile standar.Independent sample.T test was used for comparison between groups of measurement data,rank(Z)test was used for comparison between groups of abnormal distribution measurement data,comparison between the qualitative data set Chi-square test.? = 0.05 was defined as the test standard.P-valve < 0.05 was considered have statistical significance.Diagnostic value was analysis by the receiver-operating characteristic(ROC)curve.Result1.The comparison of basic information between two groups of age,gravidity and parity history,prolapse have no significance of statistics.2.Compared to simple group of patients with pelvic organ prolapse,POP-Q rating of Aa,Ba indicate have significant differences in group of patients with pelvic organ prolapse combined with occult urinary incontinence,and the difference between two groups was statistically significant(P = 0.028,P = 0.003).Selecting + 2.5 cm for Aa counter as threshold in predicting whether mergering OSUI,the area under the ROC curve was 0.642(95%CI ?0.519~0.765,P=0.03),the sensitivity was 75.6%,the specificity was 52.6%..Selecting + 3.5 cm for Ba counter as threshold in predicting whether mergering OSUI,the area under the ROC curve was 0.699(95% CI 0.583 ~ 0.815,P = 0.583),the sensitivity was 92.7%,the specificity was 60.5%.3.In the resting state,the area of levator hiatal of pelvic organ prolapse combined with occult urinary incontinence group is(21.67 ± 4.90)square centimeter.And the area of levator hiatal of simple pelvic organ prolapse group is(18.97 ± 5.27)square centimeter.Comparing the two groups,the parameters of the group of pelvic organ prolapse combined with occult urinary incontinence are more increased,and the difference between two groups was statistically significantd(P = 0.021).Selecting 16.77 cm2 for ALH in the resting state as threshold in predicting whether mergering OSUI,the area under the ROC curve was 0.647(95%CI ?0.525~0.770,P=0.024),the sensitivity was 87.8%,the specificity was 55.3%.4.In the valsalva condition,the area of levator hiatal of pelvic organ prolapse combined with occult urinary incontinence group is(31.82 ± 7.14)square centimeter.And the area of levator hiatal of simple pelvic organ prolapse group is(26.32 ± 6.60)square centimeter.Comparing the two groups,the parameters of the group of pelvic organ prolapse combined with occult urinary incontinence are more increased,and the difference between two groups is statistically significantd(P = 0.010).Selecting 31.05 cm2 for ALH in the valsalva condition as threshold in predicting whether mergering OSUI,the area under the ROC curve was 0.728(95%CI ?0.614~0.841,P=0.00),the sensitivity was 84.2%,the specificity was 58.3%.5.From resting state to Valsalva condition,the movement of the bladder neck and urethra rotation Angle 0f pelvic organ prolapse combined with occult urinary incontinence group are(24.54 ± 6.60)mm,(77.49±19.76)degrees respectively.The movement of the bladder neck and urethra rotation Angle of simple pelvic organ prolapse group are(17.42 ± 5.11)mm,(67.94±15.91)degrees respectively,.The parameters difference of two groups is significant statistical significance(P = 0.000,P = 0.021).The area of bladder neck movement distance and urethra rotation Angle under curve are 0.451,0.521 respectively,and the diagnostic value of them is very low.6.The rate of funnel-shaped urethral opening of pelvic organ prolapse combined with occult urinary incontinence group in the resting state and Valsalva condition were 36.6%(15/41),51.2%(21/41)respectively.And the rate of simple pelvic organ prolapse groups were 15.8%(6/38),23.7%(9/38)respectively.Comparing the two groups and two condition respectively,and the difference is statistically significantd(P < 0.05,P < 0.05).Conclusion1.The Aa,Ba indicating point of the former pelvic in POP-Q grading system have a certain relevance to whether the severe pelvic organ prolapse combined occult stress urinary incontinence.2.The transperineum ultrasound can show pelvic floor anatomy structure form clearly and accurately,and dynamically observe pelvic floor tissues anatomical changes in the structure from resting state to the Valsalva condition,and provide imaging anatomical location for patients who have severe pelvic organ prolapse whether merging occult stress urinary incontinence.3.Anal levator is the main part of structures in supporting pelvic structures,the damage of anal levator can lead to the incomplete of the whole pelvic floor,and lead to the severe pelvic organ prolapse merging occult stress urinary incontinence happen,anal the area of anal levator can provide the gist.4.POP-Q score combination pelvic ultrasound multiparameter observation and measurement can improve the diagnostic rate of occult urinary incontinence and accuracy,providing a new method for preoperative assessment in evaluating patients with sever pelvic organ prolapse. |
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