Long Cheng-Yu, Hsu Shih-Cheng, Wu Tung-Pi, Sun Der-Ji, Su Juin-Huang, Tsai Eing-Mei
Departments of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Reprod Med. 2004 Jan;49(1):33-7.
To compare the clinical and urodynamic characteristics of continent and incontinent women with severe uterovaginal prolapse.
Fifty-eight consecutive women with stage III or IV pelvic organ prolapse between June 1998 and December 2001 were enrolled. Each woman had a urinalysis, pelvic examination and urodynamic study and answered a urinary questionnaire. They were divided into clinically continent (n = 20) and incontinent (n = 38) groups. The clinical symptoms and urodynamic results in the 2 groups were compared statistically with the chi 2 test, Fisher's exact test and Mann-Whitney U test.
Incontinent women with severe genital prolapse were more likely to report urinary frequency, urgency and nocturia than were continent women (P < .05). However, the incidence of voiding hesitancy was significantly higher for members of the continent group as compared to the incontinent group (P = .002). With respect to urodynamic variables, including detrusor pressure at peak flow, maximal urethral closure pressure and pressure transmission ratio, significantly higher values occurred in the continent group as compared with the incontinent group; they were 38 (range, 12-66) vs. 24 cm H2O (range, 10-49) (P < .01), 84 (range, 39-117) vs. 63 cm H2O (range, 45-84) (P = .033) and 102% (range, 66-135) vs. 66% (range, 14-98) (P = .019), respectively. All other parameters and the incidence of bladder outlet obstruction and detrusor instability did not differ significantly between the 2 groups (P > .05).
The results of this study suggest that severe uterovaginal prolapse could produce obstructive symptoms and prevent or reduce urinary leakage, but whether urethral kinking or external urethral compression causes the obstruction remains unclear. More studies on different types of isolated pelvic organ prolapse are needed to elucidate the mechanism, and specific strategies can be developed to aid urogynecologists in their goal of restoring normal anatomy.
比较重度子宫阴道脱垂患者中尿控正常与尿失禁患者的临床及尿动力学特征。
纳入1998年6月至2001年12月期间连续就诊的58例III期或IV期盆腔器官脱垂患者。每位患者均进行了尿液分析、盆腔检查及尿动力学研究，并回答了一份排尿问卷。她们被分为临床尿控正常组（n = 20）和尿失禁组（n = 38）。两组的临床症状及尿动力学结果采用卡方检验、Fisher精确检验和Mann-Whitney U检验进行统计学比较。
重度生殖器脱垂的尿失禁患者比尿控正常患者更易出现尿频、尿急及夜尿症状（P <.05）。然而，尿控正常组患者排尿踌躇的发生率显著高于尿失禁组（P =.002）。在尿动力学参数方面，包括最大尿流率时逼尿肌压力、最大尿道闭合压及压力传导率，尿控正常组的值显著高于尿失禁组；分别为38（范围12 - 66）cmH₂O 与24（范围10 - 49）cmH₂O（P <.01），84（范围39 - 117）cmH₂O与63（范围45 - 84）cmH₂O（P =.033），以及102%（范围66 - 135）与66%（范围14 - 98）（P =.019）。两组间所有其他参数以及膀胱出口梗阻和逼尿肌不稳定的发生率无显著差异（P >.05）。
本研究结果表明，重度子宫阴道脱垂可产生梗阻症状并预防或减少尿失禁，但尿道扭结或尿道外压迫是否导致梗阻尚不清楚。需要对不同类型的孤立盆腔器官脱垂进行更多研究以阐明其机制，并制定具体策略以帮助妇科泌尿医生恢复正常解剖结构。
