剪切波弹性成像联合盆底超声检查评估产后压力性尿失禁患者治疗后膀胱颈变化

Evaluation of Changes in Bladder Neck after Treatment in Postpartum Stress Urinary Incontinence Patients Using Shear Wave Elastography Combined with Pelvic Floor Ultrasound

摘要: 目的：研究剪切波弹性成像(Shear wave elastography, SWE)联合盆底超声检查评估产后压力性尿失禁(Postpartum stress urinary incontinence, PSUI)患者经生物反馈电刺激联合磁刺激治疗后膀胱颈变化。方法：选取2023年1月至2024年3月来我院产后康复科就诊的45例PSUI患者为研究对象，于分娩6周后行生物反馈电刺激联合磁刺激治疗，于治疗前后采用SWE联合盆底超声记录患者静息状态、Valsalva状态下膀胱颈前后唇杨氏模量值、膀胱颈前后唇厚度、膀胱颈移动度(Bladder neck descent, BND)、膀胱颈距耻骨联合后下缘距离(Bladder neck-symphyseal distance, BSD)、膀胱尿道后角(Posterior urethra vesical angle, PUVA)、尿道旋转角(Urethral rolation angle, URA)、肛提肌裂孔面积(Levator hiatus area, LHA)、尿道漏斗形成率。结果：治疗后膀胱颈前后唇厚度变化无显著性差异(P > 0.05)，但治疗后膀胱颈前后唇杨氏模量值均显著高于治疗前(P < 0.05)。BND、PUVA、URA及LHA较治疗前明显减小(P < 0.05)；尿道内口漏斗形成率较治疗前明显降低。结论：产后压力性尿失禁与膀胱颈弹性有关；生物反馈电刺激联合磁刺激治疗能减轻尿失禁程度；SWE联合盆底超声可清楚、直观、动态地显示盆底解剖结构，在临床防治尿失禁及疗效评估中具有较好的临床价值。

Abstract: Objective: To investigate the changes in bladder neck in postpartum stress urinary incontinence (PSUI) patients treated with biofeedback electrical stimulation combined with magnetic stimulation using shear wave elastography (SWE) combined with pelvic floor ultrasound. Method: A total of 45 PSUI patients in our hospital from January 2023 to March 2024 were selected, Starting from 6 weeks postpartum, receiving biofeedback electrical stimulation combined with magnetic stimulation therapy. Before and after treatment, SWE combined with pelvic floor ultrasound was used to record the patient’s resting state, bladder neck anterior and posterior lip thickness in Valsalva state, Young’s modulus value of the anterior and posterior labia of the bladder neck, bladder neck mobility (BND), bladder neck-symphyseal distance (BSD), posterior urethrovesical angle (PUVA), urethral rotation angle (URA), levator hiatus area (LHA) and the formation rate of urethral funnel. Result: The thickness of bladder neck’s anterior lip and posterior lip had no significant difference after treatment (P > 0.05). Young’s modulus of bladder neck’s anterior lip and posterior lip after treatment were significantly higher than before (P < 0.05). BND, PUVA, URA and LHA were significantly lower than before (P < 0.05). The formation rate of urethral infundibulum is significantly reduced compared to before treatment. Conclusion: Postpartum stress urinary incontinence is related to bladder neck elasticity; Biofeedback electrical stimulation combined with magnetic stimulation can alleviate the severity of urinary incontinence; The combination of SWE and pelvic floor ultrasound can clearly, intuitively, and dynamically display the anatomical structure of the pelvic floor, and has good clinical value in the prevention and treatment of urinary incontinence and efficacy evaluation.