What is normal bladder neck anatomy?
What is normal bladder neck anatomy?
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DOI：
10.1007/s00192-015-2916-1
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发表时间：
2016-06-01
影响因子：
1.8
通讯作者：
Dietz, Hans Peter
中科院分区：
文献类型：
--
作者：
Naranjo-Ortiz, Cristina;Shek, Ka Lai;Dietz, Hans Peter
介绍和假设膀胱颈和近端尿道的功能解剖学已经被广泛研究，因为人们认为它对泌尿系统很重要。本研究的目的是探讨与压力性尿失禁（SUI）和尿动力学压力性尿失禁（USI）相关的膀胱颈盆底超声参数和尿道活动度的正常范围。方法对在三级泌尿妇科诊所接受尿动力学检查的589名女性进行回顾性研究。所有妇女进行评估后的协议，包括采访，临床检查，流量，尿动力学测试和4D盆底超声。容量数据集进行离线分析，以评估膀胱颈下降（BND），尿道旋转和膀胱后角（RVA）的最大Valsalva.Results排除妇女与以前的失禁或脱垂手术后，429个数据集。SI与RVA（p = 0.033）和BND（p = 0.036）显著相关; USI与尿道旋转（p = 0.021）和BND（p < 0.001）相关。在多因素logistic回归分析中，控制了年龄、BMI、产次、既往子宫切除术和最大尿道压力等混杂因素，SUI与BND之间的相关性仍然显著（OR [每10 mm]= 1.23; 95% CI：1.01至1.51; p = 0.043），USI和BND之间的相关性也是如此（OR [每10 mm] = 1.58; 95% CI：1.3至1.91; p < 0.001）。ROC统计BND建议截断25毫米在描述normality.Conclusions功能膀胱颈解剖措施的限制是弱相关的SUI和USI（与BND和USI之间的关联是最强的）。根据其与USI的相关性，建议将25 mm或更高的BND定义为异常（“活动过度”）。
Introduction and hypothesis Functional anatomy of the bladder neck and proximal urethra has been studied extensively because of the belief that it is important for urinary continence. The aim of this study was to explore the limits of normality for pelvic floor ultrasound parameters of bladder neck and urethral mobility associated with stress urinary incontinence (SUI) and urodynamic stress incontinence (USI).Methods A retrospective study was conducted on 589 women seen for urodynamic testing in a tertiary urogynaecology clinic. All women were assessed following a protocol including interview, clinical examination, flowmetry, urodynamic testing and 4D pelvic floor ultrasound. Volume data sets were analysed offline to assess for bladder neck descent (BND), urethral rotation and the retrovesical angle (RVA) on maximal Valsalva.Results After excluding women with previous incontinence or prolapse surgery, 429 datasets were available. SI was significantly associated with the RVA (p = 0.033) and BND (p = 0.036); USI was associated with urethral rotation (p = 0.021) and BND (p < 0.001). On multivariate logistic regression analysis, controlling for confounders including age, BMI, parity, previous hysterectomy and maximal urethral pressure, the association between SUI and BND remained significant (OR [per 10 mm]= 1.23; 95 % CI: 1.01 to 1.51; p = 0.043), as did the association between USI and BND (OR [per 10 mm] = 1.58; 95 % CI: 1.3 to 1.91; p < 0.001). ROC statistics for BND suggested a cut-off of 25 mm in describing the limit of normality.Conclusions Measures of functional bladder neck anatomy are weakly associated with SUI and USI (with association between BND and USI being the strongest). It is suggested that a BND of 25 mm or higher be defined as abnormal ("hypermobile") on the basis of its association with USI.