Application Of Real-time Shear Wave Elastography In The Diagnosis Of Female Bladder Neck Hypertrophy And Obstruction

Objective To explore the application of real-time shear wave elastography in the diagnosis of female bladder neck hypertrophy and obstruction.Methods From January 2018 to June 2019,30 female patients diagnosed as bladder neck hypertrophy and obstruction were selected into the positive group(aged from 50 to 73,mean 60.23±6.03).All the patients had not received any urinary system operations.Inclusion criteria:(1)urinary system symptoms:frequent urination,dysuria,inexhaustible micturition,prolonged micturition time,and more repeated episodes of urinary tract infection;(2)Transvaginal ultrasound showed that the anterior and posterior lips of bladder neck were thickened and raised and protruded into the bladder cavity;(3)the maximum urine flow rate and average urine flow rate decreased,and the micturition time was prolonged in varying degrees.The intravesical pressure increased significantly during micturition(>6.86 kPa,that is,>70cmH2O);(4)residual urine appeared,and the residual urine volume was higher than 50ml.In addition,42 normal women with bladder neck in urology and gynecology were selected as the control group(aged from 40-71,mean53.67±7.15).The inclusion criterias were as follows:(1)there were no symptoms of urinary system;(2)the bladder neck was smooth and free from thickening.First,the thickness of the anterior and posterior lip of the bladder neck was measured by transvaginal two-dimensional ultrasound,and the elastic coefficient of the posterior lip of the bladder neck was measured by shear wave elastography.The maximum(Emax)and average(Emean)were taken as variables.The same site was measured repeatedly for 3 times,and the average value of 3 times was taken,and finally,the residual urine volume in the bladder was measured immediately after urination.Results From the two-dimensional ultrasound picture,we can see that the anterior lip and posterior lip of bladder neck were thickened,raised and protruded into the bladder cavity with "lip" in the patients with bladder neck obstruction,while in the control group,the surface of bladder neck was smooth,the echo was clear,and there was no uplift.Transvaginal shear wave elastography(SWE)showed yellowish blue and increased hardness in ROI in patients with bladder neck obstruction and uniform blue in ROI in the control group.The thickness of anterior lip and posterior lip of bladder neck in patients with bladder neck obstruction were(0.65±10.08)cm and(0.78±0.10)cm respectively,which were higher than those of healthy subjects in control group(0.48±0.08)cm.(0.47±0.06)cm(P<0.05).The maximum Young’s modulus of obstructive patients(57.75±7.77)kPa was significantly higher than that of control group(33.55±6.84)kPa,.The average Young’s modulus of obstructive patients(45.52±6.54)kPa was significantly higher than that of control group(23.48±4.02)kPa,.In terms of residual urine volume,the residual urine volume in the bladder neck hypertrophy group was as high as(65.57±8.88)ml,which was significantly higher than that in the control group(6.38 ± 1.67)ml.Conclusion Transvaginal real-time shear wave elastography(SWE)can quantitatively reflect the stiffness of bladder neck tissue,and the Young’s modulus of bladder neck tissue can be measured by measuring the value of Young’s modulus of bladder neck tissue.It is of great significance for the clinical diagnosis of female bladder neck hypertrophy and obstruction to judge whether there is bladder neck hypertrophy and obstruction caused by bladder neck hyperplasia and hardening.