Biomechanical mechanism and treatment strategy of female bladder prolapse / 现代泌尿外科杂志

Bladder prolapse is a common disease in female,which seriously affects the physical and mental health of patients. At present,numerous treatment methods can improve the condition to some extent,but the therapeutic effect is still not satisfactory. This paper probes into the etiology of bladder prolapse from the perspective of biomechanics,explores the relationship between bladder prolapse and stress injury,and proposes corresponding treatment strategies for better management of this disease.

Research on application of pelvic four-dimensional ultrasound in early maternal pelvic floor dysfunction disease / 中国医学装备

Objective:To provide better clinical treatment plan by grading and classifying four-dimensional ultrasound pelvic floor dynamic imaging primiparas pelvic floor dysfunction.Methods: 270 cases with pelvic floor functional disorders (bladder prolapse) of high-risk mothers were selected, from the beginning of the median sagittal plane and three-dimensional reconstruction of the surface at rest, to observe the bladder and urethra and pelvic diaphragm hiatus and anal status under Valaslva changes in the measurement parameters (bladder neck mobility, posterior horn of bladder and urethra, rotation angle of the urethra) and its Green typing.Results: There was no statistical difference between the mode of delivery cystocele resting corresponding BSD and posterior horn of bladder and urethra (t=1.133,t=1.165;P>0.05). Under Valsalva state, there were significant differences the two groups corresponding to BSD, the bladder neck mobility, posterior horn of bladder and urethra and rotation angle of the urethra (t=2.147,t=5.628,t=3.502,t=4.396;P<0.05). The incidence rate of type II and type III in vaginal delivery group is higher than that in cesarean section group. The incidence rate of type I in vaginal delivery group is less than that in cesarean section group. The differences were statistically significant (x2=6.080,P<0.05). Conclusion: The pelvic floor dynamic four-dimensional ultrasound imaging can clearly show the situation of pelvic floor before primiparas to understand the situation of maternal mode of delivery cystocele production. It can provide a more reliable basis for early clinical diagnosis of maternal pelvic floor dysfunction.

Clinical Efficacy of Hochuekkito on Uterine and Bladder Prolapse—Assessment with Numerical Rating Scale and Baden-Walker grading— / 日本東洋医学雑誌

Female organ ptosis, especially uterine prolapse, is a delibilitative, dysfunctional condition of the supporting pelvic floor system of ligaments, connective tissues and muscles which manifests during pregnancy, delivery, or post-menopause. The Japanese Kampo herbal formula “hochuekkito” has been reportedly applied to uterine prolapse based on its putative ability to rejuvenate body vitality (Qi) and raise declined Qi. We assessed the efficacy of hochuekkito for uterine prolapse based on observations of its effect on clinical and objective symptoms. We administered hochuekkito to 17 patients (62.6 ± 7.1years) diagnosed with modern techniques as having uterine prolapse. The results showed that it was very effective in 6 cases (35.7%), effective in 9 cases (52.9%), and ineffective in 2 cases (11.8%). 10 patients with pessaries were all found to have been treated effectively (very effective : 4, effective : 6). In 6 patients whose compliance was below 90%, the percentage of very effective cases was 75%. The effectiveness score of hochuekkito with pelvic exercise (1.5 ± 0.5) and with pessaries (1.4 ± 0.5) was significantly higher than that with hochuekkito alone (0.8 ± 0.8) (p < 0.05). Finally, for uterine prolapse and bladder prolapse, the addition of pelvic exercise and pessaries to hochuekkito brought about more prompt improvement than that with hochuekkito alone. The increased efficacy with the addition of pelvic exercise or a pessary also helped strengthen atonic pelvic muscles, thus synergistically working together with the effects of hochuekkito.

Postnatal Management of Antenatally Diagnosed Patent Urachus with Bladder Prolapse

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.

Postnatal Management of Antenatally Diagnosed Patent Urachus with Bladder Prolapse

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.