Sokol Andrew I, Jelovsek John E, Walters Mark D, Paraiso Marie Fidela R, Barber Matthew D
Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Obstet Gynecol. 2005 May;192(5):1537-43. doi: 10.1016/j.ajog.2004.10.623.
The purpose of this study was to describe the time to adequate voiding, incidence of urinary retention, and predictors of voiding efficiency and urinary retention after tension-free vaginal tape (TVT) with and without concurrent prolapse surgery.
Medical records of patients who underwent TVT between August 1999 and July 2003 were reviewed. Urinary retention was defined as the need for urethrolysis, urethral dilation, or postoperative catheterization for >6 weeks. Linear and logistic regression models were used to determine predictors of time to adequate voiding and urinary retention.
Two hundred sixty-seven patients were available for analysis; 66% had concurrent prolapse repair, 4% had concurrent laparoscopically assisted vaginal hysterectomy (LAVH), and 30% had an isolated TVT. TVT with and without concurrent prolapse repair or LAVH were statistically similar with respect to median days to voiding (8 vs 5) and the rate of urinary retention (11.2% vs 11.3%). Overall, 4.9% underwent urethrolysis, 1.9% received urethral dilation, and 4.1% required prolonged catheterization. Increasing age, decreasing BMI, and postoperative urinary tract infection were independent predictors of time to adequate voiding. Previous history of incontinence surgery was the only independent predictor of urinary retention (Adjusted odds ratio [AOR] 2.96, 95%CI [1.17-7.06]).
Concurrent prolapse surgery does not appear to significantly alter postoperative voiding efficiency or increase the risk of prolonged urinary retention compared with TVT alone.
本研究旨在描述无张力阴道吊带术（TVT）无论是否同期行盆底器官脱垂手术时，达到充分排尿的时间、尿潴留发生率以及排尿效率和尿潴留的预测因素。
回顾了1999年8月至2003年7月期间接受TVT手术患者的病历。尿潴留定义为需要进行尿道松解术、尿道扩张术或术后导尿超过6周。采用线性和逻辑回归模型来确定达到充分排尿时间和尿潴留的预测因素。
267例患者可供分析；66%同期行盆底器官脱垂修复术，4%同期行腹腔镜辅助阴式子宫切除术（LAVH），30%仅行TVT手术。无论是否同期行盆底器官脱垂修复术或LAVH，TVT手术在排尿中位数天数（8天对5天）和尿潴留发生率（11.2%对11.3%）方面在统计学上相似。总体而言，4.9%的患者接受了尿道松解术，1.9%的患者接受了尿道扩张术，4.1%的患者需要长期导尿。年龄增加、体重指数降低和术后尿路感染是达到充分排尿时间的独立预测因素。既往尿失禁手术史是尿潴留的唯一独立预测因素（校正比值比[AOR]2.96，95%可信区间[1.17 - 7.06]）。
与单纯TVT手术相比，同期行盆底器官脱垂手术似乎并未显著改变术后排尿效率或增加长期尿潴留的风险。
