Three-dimensional Virtual-reality Reconstruction Of Pelvic Floor Structure For Patients With Female Stress Urinary Incontinence

Structure For Patients With Female Stress Urinary Incontinence Background:With the arrival of the aging of the population, stress urinary incontinence (stress urinary incontinence, SUI) has become a widespread social and healthy problems in our country which seriously endangered the large women the mind and body health and the life quality. In the urinary continence system,closure of the bladder outlet is one of the core processes and is chiefly provided by the urethra and its supporting structures and is chiefly provided by the urethra and its supporting structures. Therefore,functional or morphologic impairment of the urethra and its supporting structures is regarded as the major cause of SUI.Soft tissue resolution, muscles, tendons, fascia, fat and other soft tissues can clearly distinguish throug MRI (Nuclear magnetic resonance imaging, MRI )examination。MRI has been widely used in the study of SUI。But pelvic floor of the anatomical structure is very complex so it is very difficult to understand the anatomy of pelvic floor through the traditional two-dimensional pictures.Virtual-reality technology allows improved visualization of three-dimensional structures over conventional media.The morphologic alterations of the urethra and supporting structures were intuitive and realistic show which offers easier method to understand the complex anatomy of pelvic floor.The pathological anatomy change of patients with stress urinary incontinence becomes more clear, realistic in Virtual-reality situation. It is more easier to observe and understand the three-dimensional structure and morphology of the levator . we can measure some pelvic parameters of patients with stress urinary incontinence in the virtual system. it promotes the morphological study of Pelvic disease from qualitative study to quantify study. Three-dimensional space is closer to the true status of the people, thus it is more accurate and scientific to observe and measure pelvic parameters in Three-dimensional space than in two-dimensional space. Objective:This study was aimed to recommend Virtual-reality technology as a new method to research the relation between the morphologic alterations of thebladder ,urethra and levator and SUI.Methods:Twenty continent reference subjects and 20SUI patients underwent MR imaging.Three-dimensional Virtual-reality models of the pelvic bones,bladder,urethra and levator were created.Using 3D models, We compared the two groups for degree of the vesicourethral angle,Urethral tilt angle and mobility of the bladder neck at rest and during Valsalva effort at maximal straining. We compared the two groups for the volume of levator , the levator hiatus height and width. we still research the relationship between mobility of the bladder neck and the Clinical symptoms in SUI. we still research the relationship between mobility of the bladder neck and the volume of levator。Results: We obtained high-quality MRI images.Pelvis, bladder, urethra, levator, and obturator muscle can be clearly showed.We Can observe clearly the levatormorphology of the various components.The end of the iliac muscle was inverted "eight"-shaped;Suprapubic vaginal muscle was "V"-shaped; Puborectalis was "U"–shaped. Funneling at the Bladder Neck and shorter urethra were found in two patients with SUI.The group with SUI had a greater vesicourethral angle (141.27°vs113.38°) ,urethral inclination angle (36.27°vs21.96°),larger the mobility of the bladder neck(15.67vs 7.87mm), during Valsalva effort at maximal straining.The group with SUI had a larger levator hiatus height , width and smaller the volume of levator than did the women who were continent (p< 0.05). there is a positive relation between and the Clinical symptoms. there is a negative relation between mobility of the bladder neck and the volume of levator。Conclusions:1,MRI is a effective image method to research SUI.2. Three-dimensional virtual reality models of the female pelvic floor can enhance our understanding of pelvic floor anatomy .3. Virtual-reality technology is a new,innovative,effective method to reveal significant morphologic alterations of the urethra and supporting struct ures in patients with SUI.4.We can measure correctly the vesicourethral angle,Urethral tilt angle and so on in Virtual-reality system ,so it offers a more scientific research method.5. Bladder and posterior urethra can be showed intuitively in virtual reality environment。We can judge intuitively anatomic SUI or urethral sphincter dysfunction through MRI-based virtual reality reconstruction。It is helpful to select surgery methods for clinical doctor。6.The hypermobility of the urethra is one of factors in SUI patients.7.Urethral intrinsic sphincter deficiency is one of factors in SUI patients.8,The mobility of the bladder neck and urethral inclination angle had significant positive correlation with the severity of SUI.They are the effective parameters of the activity of the bladder neck。9,The laxity of pelvic floor is one of factors in SUI patients.