| PART 1: Middle-late gestation by two-dimensional transperineal pelvic ultrasound and stress urinary incontinence: a correlation analysis ObjectiveThis study aims to investigate the characteristics of transperineal pelvic ultrasound among middle-late gestational women and provide imaging basis for the correlation analysis between gestation and stress urinary incontinence.MethodsAntenatal examinations were conducted among patients visiting the department of obstetrics in The First Affiliated Hospital of Guangzhou Medical University between May 2013 and June 2016,among which middle-late gestational subjects(gestational age of 14 to 40 weeks)meeting criteria were enrolled in the present study and urinary incontinence evaluation form recorded(Table 7).Enrollment criteria included absence or presence of involuntary urine leakage for at least three times when sneezing,laughing,or lifting heavy objects.All subjects were divided into the incontinence group(34 cases)and the non-incontinence group(40 cases).Subjects were under the resting state or accepted maximum Valsalva activity prior to pelvic two-dimensional ultrasound and the characteristics of pelvic ultrasound including the bladder neck angle(βr,βs),the bladder neck rotation angle(△β),the bladder neck movement degrees(BND),the posterior urethra-vesical angle(θr,θs),and the urethral rotation angle(△ɑ)evaluated.Comparative analysis independent sample t test and partial correlation analysis were conducted between different groups,P<0.05 was considered statistically significant.Clinical characteristics including age,gestational week,BMI,gravidity and parity history between the two groups showed no statistically significant difference(P>0.05).Informed consent were signed.Results1.Among the 34 cases of mid-late gestation women with SUI,5 of them were diagnosed SUI during early gestation,20 demonstrated SUI during mid gestation,9 showed SUI during late gestation.2.Compared with the non-incontinence group,the bladder neck rotation angle,BND,the bladder neck angle and posterior urethra-vesical angle during the max Valsalva activity prior of incontinence group were all significantly higher(t=3.18,3.138,2.765,3.401 respectively,all P<0.05).Moreover,the urethral rotation angle,bladder neck angle and posterior urethra-vesical angle during the resting state of incontinence group were higher in comparison to the non-incontinence group,however without statistical difference(t=1.602,0.859,1.711,all P>0.05).2.Moderate correlation between urethral rotation angle and gestation week in the incontinence was observed(partial correlation coefficient=0.378,P<0.05).ConclusionOur study revealed obvious changes of the supportive structure around bladder urethreal tissues in middlde-late gestation women that with the increase of gestation week,urethral rotation angle increased.Evaluation of bladder neck rotation angle,BND,bladder neck angle and posterior urethra-vesical angle after maximum Valsalva stimulation is of high value in clinical practice,providing evidence for postpartum pelvic floor rehabilitation.PART 2:Evaluation of the curative effect of pelvic floor rehabilitation in the treatment of stress urinary incontinence ObjectiveThis study aims to investigate the curative effect of stimulation and biofeedback combined with Kegel training on the recovery of pelvic floor function in women with mild to moderate stress urinary incontinence(SUI).Methods78 patients with mild to moderate SUI treated in Guangzhou Medical University First Hospital from May 2013 to June 2016 were enrolled in the present study.The patients were randomly divided into the treatment group(n=39)managed by electric stimulation and biofeedback combined with Kegel training and the control group(n=39)treated by Kegel alone.To analyze the recovery of pelvic functions in patients with mild and moderate SUI prior to,3-month and 6-month post rehabilitation therapies,questionnaire survey,pelvic floor muscle strength,uroflowmetry,pad test and pelvic ultrasonography were performed and the curative effect of electrophysiological therapy were evaluated.The independent samples t test was adopted for comparison between groups and the paired samples t test for comparison within one group.Qualitative data was analyzed by Х2 test and rank sum test.P<0.05 was considered to be statistically significant.Results1.The questionnaire scores and life quality of both the treatment group and the control group significantly improved after 3-month and 6-month treatment(P<0.01).2.The pelvic floor muscle strength of both groups markedly improved after 3-month and 6-month treatment(P<0.05).Compared with 3-month treatment,the muscle strength in the control group markedly improved after 6-month treatment(P<0.05).3.The differences of Qmax,Qave and TQmax between the treatment group and the control group after 3-month and after 6-month treatment were not statistically significant(P>0.05).4.In the treatment group,leaked volume significantly reduced after 6-month treatment compared with before treatment(P<0.05).5.Compared with prior to treatment,the urethral rotation angle,the bladder neck movement degrees and the posterior urethra-vesical angle in the treatment group under resting state reduced after 3-month and 6-month treatment respectively;in the treatment group,the posterior urethra-vesical angle under Valsalva action significantly decreased after 6-month treatment(P<0.05).In the control group,the urethral rotation angle reduced after 3-month treatment and after 6-month treatment as compared with before treatment;the posterior urethra-vesical angle under Valsalva action significantly decreased after 6-month treatment(P<0.05).ConclusionsNot only electric stimulation and biofeedback combined with Kegel training but also kegel training alone can improve supporting structures surrounding urinary tract in patients with SUI..Moreover,the curative effects of electric stimulation and biofeedback combined with Kegel training could last for six months,better than Kegel training alone. |
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