Goldberg R P, Koduri S, Lobel R W, Culligan P J, Tomezsko J E, Winkler H A, Sand P K
Department of Evanston Continence Center, Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University Medical School, Evanston Northwestern Healthcare, Illinois, USA.
Am J Obstet Gynecol. 2001 Dec;185(6):1307-12; discussion 1312-3. doi: 10.1067/mob.2001.119080.
The purpose of this study was to evaluate the independent effect of suburethral sling placement on the risk of cystocele recurrence after pelvic reconstructive operation.
One hundred forty-eight women with cystoceles to or beyond the hymenal ring underwent pelvic reconstructive operation, with or without incontinence procedures, and were evaluated at 12 and 52 weeks after operation with a standardized pelvic examination. Rates of recurrent prolapse, at all sites, were statistically compared between subjects with and without suburethral slings. A multiple regression analysis was used to determine the independent effect of sling placement on the risk of recurrent cystoceles.
Suburethral sling placement was associated with a 54.8% reduction in the mean rate of postoperative cystocele recurrence (P =.004). This protective effect was observed as early as 12 weeks and remained significant at 1-year follow up (42% vs 19%). A markedly reduced risk of cystocele recurrence was observed when women with sling procedures were compared with all other women, with those women who underwent other incontinence operations, and even with those women who had undergone prolapse repair with no incontinence procedure. The protective effect of the sling procedure remained highly significant (odds ratio, 0.29; P =.0003), even after controlling for potentially confounding variables in a multiple logistic regression model.
Suburethral sling procedures appear to significantly reduce the risk of cystocele recurrence after pelvic reconstructive operation, in contrast with the effect of retropubic urethropexy and needle suspensions. These findings should be considered when the surgical treatment of stress incontinence that accompanies pelvic organ prolapse is being planned.
本研究旨在评估耻骨后尿道悬吊术对盆腔重建术后膀胱膨出复发风险的独立影响。
148例膀胱膨出至处女膜环或超过处女膜环的女性接受了盆腔重建手术，手术中或未行抗尿失禁手术，并在术后12周和52周接受标准化盆腔检查进行评估。对有或无耻骨后尿道悬吊术的受试者在所有部位的复发脱垂率进行统计学比较。采用多元回归分析确定吊带放置对复发性膀胱膨出风险的独立影响。
耻骨后尿道悬吊术使术后膀胱膨出平均复发率降低54.8%（P = 0.004）。这种保护作用在术后12周时就已观察到，在1年随访时仍很显著（42%对19%）。与所有其他女性、接受其他抗尿失禁手术的女性以及甚至未行抗尿失禁手术的脱垂修复女性相比，接受吊带手术的女性膀胱膨出复发风险显著降低。即使在多元逻辑回归模型中控制了潜在的混杂变量后，吊带手术的保护作用仍然非常显著（优势比，0.29；P = 0.0003）。
与耻骨后尿道固定术和穿刺悬吊术的效果相比，耻骨后尿道悬吊术似乎能显著降低盆腔重建术后膀胱膨出的复发风险。在计划对伴有盆腔器官脱垂的压力性尿失禁进行手术治疗时应考虑这些发现。
