Evaluation Of Perineal Real-Time Three-Dimensional Ultrasound Applied In Women With Stress Urinary Incontinence And The Efficiency Of TVT-O

ObjectiveThis paper is to explore the utility of perineal ultrasound in female SUI and postoperative assessment of tension free vaginal tape-obturator(TVT-O):to observe the anatomical and functional changes in female SUI patients' pelvic floor by real-time three-dimensional ultrasound,and analyze the image and parameters obtained from it.MethodsIn this study,there are 56 women SUI patients hospitalized in the department of Obstetrics and Gynecology in General Hospital of Shenyang Military Area Command(2015.8-2016.10)as SUI group,50 normal women as control group.By observing static and dynamic images of perineal realtime three-dimensional ultrasound of SUI group(before and after TVT-O)and control group at state,on Valsalva and contraction,assess parameters as the bladder neck descent value,retrovesical angle,urethral tilt angle,the anteroposterior diameter of levator hiatus,the transverse diameter of levator hiatus,the area of levator hiatus,pubovisceral muscle thickness,and whether or not the funnel formation in internal urethral orifice.56 patients who had undergone TVT-O surgery were grouped according to different clinical sfficacy 24 hours after the operation,real-time three-dimensional ultrasound detect the positionand form of the material implanted,measuring sling angles for comparison.Analyze the images preserved for post-processing.T test was used to compare the results of each group,and the chi-square test was used to compare the variance rate,the difference was statistically significant if P<0.05.Results1.The pelvic floor structure showed by real-time three-dimensional ultrasound is similar to the human anatomy,by this way we can obtain intuitive and dynamic observation of the bladder neck,urethra,vagina,rectum,levator muscle and other pelvic structures,and real-time threedimensional ultrasound can show the location,form and activity of the material implanted clearly after TVT-O.2.Bladder neck,urethral activity comparison:at resting state,bladder neck and posterior urethra-vesical angle of SUI group and the control group showed no contrasted change(P>0.05);On Valsalva,SUI group is statistically significant bigger than the control group at bladder neck descent,retrovesical angle and urethral tilt angle(P<0.05);There are statistically significant differences between before and after TVT-O at bladder neck descent,retrovesical angle and urethral tilt angle(P<0.05);No significant differences were found between after TVT-O procedure and the control group(P>0.05);In the SUI group,48 cases had different degrees of urethral opening on Valsalva,which was funnelshaped(48/56,85.7%).There were 5 cases of the funnel formation in internal urethral orifice(5/50,10%)in the control group,the difference was statistically significant(P<0.05).3.Comparison of the anteroposterior diameter of levator hiatus,the transverse diameter of levator hiatus,the area of levator hiatus,pubovisceral muscle thickness:at resting state,there was no statistically differences at the anteroposterior diameter besides transverse diameter?the transverse diameter of levator hiatus and the area of levator hiatus between SUI group and the control group(P>0.05),but less pubovisceral muscle thickness in SUI group(P<0.05);On Valsalva,the anteroposterior diameter and pubic area of levator hiatus were larger in SUI group than in the control group,pubovisceral muscle thickness was less in SUI group on the contrary,with statistically differences(P<0.05);On contraction state,there were statistically differences between SUI and the control group(P<0.05);In SUI group,there were statistically differences in pubovisceral muscle thickness before and after TVT-O,at rest(P<0.05),but there was no statistically difference in anteroposterior diameter besides the transverse diameter and the area of levator hiatus(P>0.05);On Valsalva and contraction state,the anteroposterior diameter of levator hiatus was smaller than before the operation,with statistically differences(P<0.05),the transverse diameter,the area of levator hiatus,and pubovisceral muscle thickness were without statistically differences(P>0.05);There were statistically differences after TVT-O procedure in pubovisceral muscle thickness,in all the three position(P<0.05);The area of levator hiatus of SUI was bigger than the control group on Valsalva and contraction state,with statistically differences(P<0.05).4.Out of 56 patients,46 cases were cured and 10 cases were improved.The parameters of two groups for sling angle during Valsalva menaver was different(P<0.05).Conclusions1.The real-time three-dimensional ultrasound via perineum is ableto make an accurate assessment of ultrasound image traits of patients with SUI as well as an accurate assessment of pelvic structure and function.2.The bladder neck descent value,retrovesical angle,urethral tilt angle,the anteroposterior diameter of levator hiatus,the ladder neck descent,the anteroposterior diameter besides transverse diameter and the area of levator hiatus,pubovisceral muscle thickness and urethral funneling are significant parameters in diagnosis of SUI.3.Real-time three-dimensional ultrasound played an important role in TVT-O postoperative assessment.