Chaikin D C, Groutz A, Blaivas J G
Weill Medical College, Cornell University, New York, New York, USA.
J Urol. 2000 Feb;163(2):531-4.
We determined the indications for anti-incontinence surgery in continent women undergoing surgical repair of severe urogenital prolapse.
We prospectively evaluated 24 continent women referred for evaluation of severe urogenital prolapse. All patients underwent a meticulous clinical evaluation, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test, cotton swab test, video urodynamics and cystoscopy. The urodynamic evaluation was repeated with prolapse repositioning by a fitted vaginal pessary. Surgical intervention was tailored according to urodynamic findings.
Reduction of prolpase with a pessary unmasked sphincteric incontinence in 14 women (58%). Ten women with no urodynamic evidence of sphincteric incontinence underwent anterior colporrhaphy and no additional anti-incontinence procedure was performed. Mean followup was 44 months (range 12 to 96). None had postoperative stress incontinence but 1 (10%) had a recurrent grade 2 cystocele. The 14 remaining women with sphincteric incontinence after prolapse reduction underwent anterior colporrhaphy with a pubovaginal sling procedure. Mean followup in these cases was 47 months (range 12 to 108). In 2 patients (14%) stress incontinence developed postoperatively and 1 (7%) had a recurrent grade 3 cystocele. The incidence of urge incontinence did not appear to be significantly influenced by either surgical intervention. Overall 12 patients had preoperative urge incontinence, of whom 9 (75%) had persistent urge incontinence postoperatively. In another woman new onset urge incontinence developed.
Preoperative urodynamic evaluation with and without prolapse reduction is essential for making the correct diagnosis of masked stress incontinence in women with urogenital prolapse. The decision to perform a concomitant prophylactic anti-incontinence procedure should be tailored to individual urodynamic findings. Larger series and longer followup are needed to establish the most effective preventive procedure for this troublesome clinical problem.
我们确定了接受严重泌尿生殖系统脱垂手术修复的控尿女性患者抗尿失禁手术的适应证。
我们前瞻性评估了24名因严重泌尿生殖系统脱垂前来评估的控尿女性患者。所有患者均接受了细致的临床评估，包括完整的病史和体格检查、尿失禁问卷、排尿日记、护垫试验、棉拭子试验、影像尿动力学检查和膀胱镜检查。通过合适的阴道子宫托将脱垂复位后重复进行尿动力学评估。根据尿动力学检查结果进行手术干预。
使用子宫托减轻脱垂后，14名女性患者（58%）出现了括约肌性尿失禁。10名无括约肌性尿失禁尿动力学证据的女性患者接受了前阴道壁修补术，未进行额外的抗尿失禁手术。平均随访44个月（范围12至96个月）。无一例患者术后出现压力性尿失禁，但有1例（10%）出现复发性2级膀胱膨出。其余14名脱垂减轻后出现括约肌性尿失禁的女性患者接受了前阴道壁修补术加耻骨后阴道吊带术。这些病例的平均随访时间为47个月（范围12至108个月）。2例患者（14%）术后出现压力性尿失禁，1例（7%）出现复发性3级膀胱膨出。急迫性尿失禁的发生率似乎未受到任何一种手术干预的显著影响。总体而言，12例患者术前存在急迫性尿失禁，其中9例（75%）术后仍存在急迫性尿失禁。另有1名女性患者出现新发急迫性尿失禁。
对于泌尿生殖系统脱垂女性患者，术前进行有或无脱垂复位的尿动力学评估对于正确诊断隐匿性压力性尿失禁至关重要。是否进行预防性抗尿失禁手术应根据个体尿动力学检查结果来决定。需要更大规模的系列研究和更长时间的随访来确定针对这一棘手临床问题的最有效预防措施。
