Study On Urodynamics And Pelvic MRI In Female Pelvic Organ Prolase

Objective: Through adopt the method of urodynamics and pelvic MRI in the patients with pelvic organ prolapse,to analyze the changes of bladder and urinary function and anatomical structure of patients with occult stress urinary incontinence in pelvic organ prolapse,to discuss the urodynamics characteristics of patients with pelvic organ prolapse and the diagnostic value of dynamic MRI in female pelvic organ prolapse.Methods: In the third affiliated Hospital of Zunyi Medical College,from December 2016 to December 2017,21 patients with clinical diagnosis POP Group,21 patients in POP+SUI group,and 15 patients in the same period were selected as control group.(1)All patients with POP,POP+SUI and control group were assessed by pelvic floor function questionnaire to understand the severity of symptoms and the impact on quality of life.Pelvic organ prolapse quantitative staging(POP-Q)was used to evaluate the degree of prolapse.(2)Urodynamics using ANDROMEDA detection instruments,of uroflowmetry,pressure-flow studies,urethral pressure measurement and observation maximum flow rate,maximum cystometric capacity,abdominal leak point pressure,maximum urethral closure pressure,detrusor pressure at Maximum flow,evaluation of bladder and urethra function.(3)Complete the pelvic dynamic MRI and the urodynamics examination before the treatment of all patients.Drinking water in the pelvic MRI before half an hour,keep the bladder half filling state as image contrast,and ensure that the patient can complete the Valsava action before the scan.The scanning uses the Siemens 1.5T Magnetic resonance machine,when the examination,patients with lithotomy position relax lying on the examination bed for the resting period,routine transverse,sagittal and coronal scanning.Then the patient was ordered to increase the abdominal pressure,complete the Valsalva action,complete the transverse and sagittal scan.The measurement results were analyzed by measuring the PCL length,H-line length,M-line length,the transverse diameter of pelvic diaphragm hiatus,retro vesicourethral angle,urethral inclined angle,and the MRI diagnosis according to the HMO degree.Results: Results:(1)Anterior pelvic and / or middle pelvic prolapse were the main cases in 42 patients.anterior pelvic prolapse accounted for 95.2%,the middle pelvic prolapse accounted for 80.9%.Cystocele was higher in Ⅱ period and Ⅲ period,and the rate in Ⅱ period was 45.2%.And it was 40.5% in III period.(2)Through clinical interrogation and gynecological examination,21 cases of simple POP patients and POP with SUI patients in 21 cases,urodynamic examination,measured simple bladder outlet obstruction in 8 cases,the maximum urethral closure pressure reduction in 11 cases,measured ALPP 27 cases,the simple POP with OSUI in 6 cases.According to the Ba points of vaginal anterior wall of POP-Q,when Ba points was located at-1.0~+1.0cm,the diagnostic rate of SUI was 59.3%,while the diagnosis rate of bladder outlet obstruction was 75% when Ba was at +1.1 ~ +8.0cm.(3)The H-line length,M-line length and the transverse diameter of pelvic diaphragm hiatus of the POP group were all more than the POP+SUI group and control group were prolonged,the difference was statistically significant(P<0.05).There was no statistically significant difference between 3 groups of PCL and P=0.209.At Valsalva maneuver,RVA and UIA were significantly increased in the SUI+POP group,and the difference was statistically significant(P<0.05).(4)POP-Q and dynamic MRI diagnosis of POP kappa test results: Anterior pelvic K=0.540(P=0.001),consistent strong,middle pelvic K=0.211(P=0.026),the consistency is weak,posterior pelvic K=0.358(P=0.002),weak consistency.Comparing the results of POP-Q measurement and dynamic MRI measurement,Spearman correlation analysis results: the correlation between the two methods of middle pelvic prolapse was better,r=0.609(P<0.01),the correlation between the measured values of the anterior pelvic prolapse was second,r=0.577(P<0.01),and the correlation between the two methods of prolapse of posterior organs was poor,r=0.412(P<0.05).Conclusion: Conclusion: Pelvic dynamic MRI can effectively show the change of pelvic floor organ and its support structure,which plays an important role in identifying POP and POP+SUI,and can be used as a pelvic floor function evaluation method.Dynamic MRI combined with urodynamics is helpful for the diagnosis of POP and POP+OSUI,and the effective evaluation of bladder urethral function.