目的 比较经会阴盆底超声和尿动力学检查在女性混合性尿失禁(MUI)的评估及其相关性。方法 2010 年9 月至2017 年12 月，纳入MUI患者(n=118)和对照者(n=30)，详细记录临床基线资料。MUI患者分为压力性为主混合性尿失禁(S-MUI，n=51)、急迫性为主混合性尿失禁(U-MUI，n=34)和两者相当混合性尿失禁(E-MUI，n=33)三类。患者先后进行经会阴盆底超声检查和尿动力学检查，问卷调查两种检查方法舒适性。结果 经会阴盆底超声结果显示，S-MUI患者膀胱尿道后角、尿道前倾角、耻骨联合下缘与膀胱颈口距离、膀胱颈口移动度均显著大于对照组(P<0.001)；U-MUI患者膀胱壁厚度及E-MUI患者膀胱颈口移动度均大于对照组(P<0.05)。尿动力学检查结果显示，S-MUI患者最大尿道闭合压、功能尿道长度显著小于对照组(P<0.001)；U-MUI患者最大尿流率、尿量小于对照组(P<0.05)，而尿道开放时逼尿肌压、最大尿流率时逼尿肌压、逼尿肌过度活动均显著大于对照组(P<0.001)；E-MUI患者最大尿流率时逼尿肌压大于对照组(P<0.05)，而最大尿道闭合压小于对照组(P<0.05)。以上所有参数在S-MUI患者和U-MUI患者间均有显著性差异(P<0.05)。膀胱颈口移动度、尿道前倾角、耻骨联合下缘与膀胱颈口距离，与最大尿流率时逼尿肌压、功能尿道长度之间呈负相关；而膀胱壁厚度与最大尿流率时逼尿肌压、功能尿道长度之间呈正相关。82.3%患者认为经会阴盆底超声检查舒适性优于尿动力学检查。结论 经会阴盆底超声检查参数与尿动力学检查指标在不同类型MUI患者临床评估方面存在显著相关性。与尿动力学检查相比，经会阴盆底超声检查因其舒适性而容易被广大患者接受。尤其对于U-MUI患者，超声检查可以通过测量膀胱壁厚度来间接反映膀胱出口梗阻，更有益于U-MUI评估。
Objective To compare urodynamic studies (UDS) and perineal sonography for assessing mixed urinary incontinence
(MUI) in women.Methods A total of 118 adult females with MUI and 30 controls were enrolled from September, 2010 to December,2017. Their baseline clinical characteristics were recorded. The MUI patients were divided into stress-predominant (S-MUI, n=51), urge- predominant (U-MUI, n=34) and equal predominance (E-MUI, n=33) according to
King's Health Questionnaire. Both UDS and perineal sonography were performed in all the subjects. Tolerability
of the two methods was compared. Results For sonography parameters, compared with the controls, S-MUI patients had greater dynamic posterior urethral angle, dynamic angle of urethral inclination, dynamic pubo- urethral distance and descent of bladder neck (P< 0.001), U-MUI patients had greater detrusor thickness (P<0.05), and E-MUI patients had greater descent of bladder neck (P<0.05). For UDS parameters, compared with the controls, S-MUI patients had lower Pure.clos.max
and functional urethral length; U-MUI patients had lower Qmax, smaller bladder volume, higher Pdet.open, higher
Pdet.Qmax and higher incidence of detrusor overactivity; and E-MUI patients had higher Pdet.Qmax and lower
Pure.clos.max (P<0.05). All UDS and sonography parameters differed significantly between S- MUI and
U-MUI patients. The descent of the bladder neck, dynamic angle of urethral inclination, and dynamic pubourethral
distance were negatively correlated with detrusor pressure at maximal flow and functional urethral length,
while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional
urethral length. Perineal ultrasound was better tolerated than UDS in 82.3% patients.Conclusion Perineal sonography parameters show good correlation with UDS parameters. Ultrasonography is better tolerated than UDS and provides additional morphologic data. Perineal sonography could facilitate to diagnose U-MUI.
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