Evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction / 中华妇产科杂志

ABSTRACT

Objective To evaluate transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction. Methods Eighty-three patients with severe pelvic organ prolapse received surgeries in Fuzhou General Hospital from September 2014 to September 2015, dividing into two groups27 patients were selected to receive transvaginal mesh (TVM) pelvic floor reconstruction surgery with tension-free vaginal tape-Abbrevo (TVT-Abbrevo) incontinence surgery, named TVM+TVT-Abbrevo group;56 patients were selected to receive TVM pelvic floor reconstruction surgery only, named TVM group. The ultrasonic parameters at rest, on contraction and Valsalva condition respectively were observed and measured, including the bladder neck descent (BND), urethral rotation angle, retrovesical angle, levator urethra gap (LUG), the existence of bladder neck funneling, position of the tape, by using 2D and 3D transperineal ultrasound. Results The two groups were compared with the ultrasonic parameters before and after operation two groups of patients with postoperative BND [(2.3 ± 0.5) versus (3.1 ± 0.7) cm, (1.6 ± 0.4) versus (3.6±0.4) cm] were significantly reduced, the difference was statistically significant (P=0.02, P<0.01). The two groups of LUG before and after operation [(3.62 ± 0.45) versus (3.26 ± 0.92) cm, (2.96 ± 0.47) versus (2.72 ± 0.38) cm] both had significant difference by maximum Valsalva (P<0.01, P=0.04). There was statistical significance difference of urethral rotation angle in TVM+TVT-Abbrevo group by maximum Valsalva (P=0.01). Observation of morphology(1) 2 patients with difficulty in urination in TVM+TVT-Abbrevo group, ultrasound showed when the position of the bladder down the urethra discount;4 patients with stress urinary incontinence (SUI), ultrasound showed slings off or release. (2) One patient with difficulty in urination in TVM group, but ultrasound showed lower urinary tract anatomy were normal; 5 patients with SUI, ultrasound showed the position of the bladder neck were significantly lower in 3 patients, showing high mobility, and the other 2 patients had a larger urethral diameter, showing a tendency of natural deletion. Conclusions Anatomy of lower urinary tract could be clearly showed by transperineal sonography. This could provide imaging support for the diagnosis of lower urinary tract symptoms after pelvic floor reconstruction.