| Objective: To elucidate the significance of urodynamic testing in clinical diagnosis, investigate the role of urodynamic associated with perineal ultrasonography on the the vesicourethral functional evaluation in patients with stress urinary incontinence, and further investigate the mechanism of urinary continence after tension-free vaginal tape obturator (TVT-O) procedure.Methods: In the first part, 169 female outpatients with urinary incontinence were included, clinical history was collected and urodynamic testing was performed for clinical and urodynamic diagnosis, respectively. In the second part, 24 patients with SUI and 15 controls were underwent Urodynamic test to determine the normal desire to void, maximum void, voided at higher pressure, abdomen leak point pressure, urethral length, functional urethral length, continence zone, continence zone/ urethral length, maximum urethral closure pressure at pre-operation,1 month and 3 months after operation. In addition, at pre-operation and 3 months after operation, perineal ultrasonography was performed for Mu, posterior urethra-vesical angle(αr,αs) and the urethral knee angulation (βr,βs) at rest or during the Valsalva maneuver. Furthermore, the distance between bladder neck and the middle of the tape (D) was also measured at rest at 3 months after operation.Results: (1) 54% of the 169 urinary incontinent patients are clinically diagnosed as MUI, 28% SUI, and 18% UUI. However, 45% of them are finally diagnosed as USUI, 21% UMUI, 16% DO, and 18% NUI by urodynamic testing. Although the clinical diagnosis is related to urodynamic diagnosis (Χ~2=18.94, P = 0.001), the results exhibit a significant difference (P < 0.001) with a worse consistency (Kappa value is 0.16) between them. (2) FUL, Z, Z/UL and MUCP in SUI group were significantly reduced compared with control (all P < 0.05). In the control, urethral pressure profile showed a slick and symmetric property,however the curves are varied wth a decreased area under curve and an impaired urethral close function in SUI group. The mean operative duration of TVT-O is 17min, with better relief from clinical symptoms and fewer intra- or post-operative complication. ALPP was appeared at pre-operation, but not at post-opration. There were no significant differences in ND and Pdet.Qmax between pre- and post-operation. At 1 month after operation, Qmax was significant decreased compared with pre-operation or 3 months after operation (all P < 0.05), UL, FUL, Z and Z/UL were all increased compared with pre-operation (all P < 0.05), but not significantly different when they were compared with 3 months after operation. While the MUCP did not differ between pre- and 1 month after operation. At 3 month after operation, FUL, Z and Z/UL were persistently increased compared with pre-operation (all P < 0.05), but did not significantly differ from the control. Meanwhile, significantly reduced UL and MUCP compared with the control, and increased UL and MUCP compared with pre-operation were observed. However, by 3 month after operation, there were no difference in Qmax compared with pre-operation or control.(3) Promimently increased Mu,αr,αs and decreasedβr,βs were found in SUI group before operation compared with 3 months after operation or with control (all P < 0.01). However, no significant differences in them were observed in the comparision of control and SUI group at 3 months after operation. In addition, the distance between bladder neck to the middle of the tape was 18.23±1.73 mm, The D/UL was 52.6±2.96 (%). (4) Compared with non-ISD group, UL,FUL,Z,Z/UL and MUCP were significantly declined and Qmax showed significantly enhanced in ISD group before operation (all P < 0.01). By 3 months after operation, except MUCP which was reduced in ISD group, there were no longer any differences in Qmax, UL, FUL, Z, Z/UL, and the discrepancy before and 3 month after operation of MUCP between these two groups. Likewise, there were no significant differrences in all of the ultrasound parameters between these two groups.Conclusions: Clinical diagnosis based on clinical history has a bad consistency wth urodynamic diagnosis, thus it can not be used to accurate diagnose urinary incontinence. Patients with SUI exhibit disturbances in static and dynamic urethral closure function, and disorders of weakness in bladder neck and periurethral supporting tissue. There were significant differences in vesicourethral function but not in anatomic morphological changes between ISD and non-ISD groups. TVT-O procedure exerts its actions on urinary continence through the recovery of normal anatomic position and morphous attributed to improved urethral closure function and enhanced supporting tissue. Therefore, urodynamic testing associated with perineal sonography may play an important role in the diagnosis of SUI and the follow-up visit after TVT-O procedure.
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