基于SUI尿道运动曲线研究MUS在体生物力学作用并构建术后尿控预测模型

Female stress urinary incontinence (SUI) was defined as the complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing, with an incidence of 16-36％ in aged women in the world, becoming an important impact on the life quality of patients. The mid-urethral sling (MUS) surgery has been the first-line operation for SUI. It is a challenge to avoid a postoperative SUI or voiding dysfunction (VD) in 10-20% of SUI women. The hypermotive urethra may be the pathogenesis of SUI. It is the key point to predict the surgical outcome that to elucidate the relationship between the biomechanical effect of MUS and the changes of urethral mobility. Urethral motion profile (UMP) is a new methodology to assess the mobility of the whole urethra by determining the segmental mobility vectors of the urethra, relative to the symphysis pubis, using the ultrasonographic volume data. Early studies indicated that the hypermotive mid-urethra was likely to be the pathogenesis of SUI; the biomechanical effect of MUS was related to mid-urethral mobility. Recently, for the first time, we proved that MUS worked by lowering mid-urethral mobility and rising voiding pressure(J Urol. 2018; 199(6):1571-1576. IF: 5.38). If the pressure exerted by MUS on the urethra and the relationship to the postoperative symptoms can be further quantified, better outcome may be achieved using individualized surgical strategy. This project is designed to further explore the pathogenesis of SUI and the biomechanical effect of MUS using UMP, discover the relationship between imaging findings and surgical outcomes and build a prognostic model in SUI women, for a likelihood of an intelligentialized surgical strategy formulation and therapeutic effect prediction in the future.

压力性尿失禁(SUI)严重影响妇女生活质量且发病率高，已成为全球性重要健康问题。尿道中段吊带术(MUS)是治疗SUI的首选术式，精确衡量MUS的生物力学作用是实施精准手术、避免术后尿失禁复发和排尿困难的前提。尿道高活动度是SUI发生的主要机制。通过四维盆底超声测定尿道运动曲线（UMP）定量评估尿道全程活动度发现SUI尿道中段活动度高。我们的前期研究证实MUS对尿道施加动态压力使尿道中段活动度降低、排尿阻力增大（J Urol. 2018; 199(6):1571-1576. IF: 5.65）。我们设想尿道中段活动度与SUI发生相关、与MUS的生物力学作用及术后尿控相关。本研究拟应用UMP建立尿道运动曲线图；计算MUS术后尿道活动度的改变并量化评估MUS对尿道施加的压力，分析MUS的生物力学作用与术后症状的关系，构建术后尿控预测模型；为精准手术提供依据，为个体化、智能化手术策略制定奠定基础。

尿道中段吊带术(MUS)是治疗女性压力性尿失禁（SUI）的首选术式，但是术后SUI复发仍达到约20%。精确衡量MUS的生物力学作用是实施精准手术、提高手术成功率的前提。尿道高活动度是SUI发生的主要病理机制。MUS在体生物力学作用对尿道活动度的影响及其与患者临床结局的关系有待研究。.本项目首次应用实时超声记录咳嗽压力试验（CST，临床SUI诊断实验）过程中尿道解剖变化，通过与正常女性尿道运动曲线比较，发现尿道中段高活动度是实时漏尿状态下SUI的主要解剖改变；我们首次通过可视化尿道运动曲线（UMP）分析方法呈现了不同压力状态下尿道相对耻骨联合的位置变化，发现腹压增大时尿道围绕耻骨联合的旋转下移是女性尿道控尿的关键；SUI妇女尿道中段与耻骨联合之间的距离增大、尿道中段活动度增加，且这一解剖特征不随体位改变而变化；我们的研究证实MUS对膀胱颈部解剖的影响与临床结局无关，MUS减低了尿道中段活动度；超声测量“吊带耻骨间距（SPG）”是衡量MUS在体生物力学作用的有效参数，SPG与尿道中段活动度相关，与临床结局相关；SPG越宽，术后SUI复发风险越高；建立了SUI术后复发预测曲线。.本项目在论证SUI尿道高活动度发生机制和MUS的治疗机制的基础上，提出了SUI术前术后评估的超声新方法，研究结果可直接应用于临床诊疗，将有助于改进MUS 手术策略、提高手术成功率。

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