Clemons Jeffrey L, Aguilar Vivian C, Sokol Eric R, Sung Vivian W, Myers Deborah L
Division of Urogynecology, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Wash 98431, USA.
Am J Obstet Gynecol. 2005 May;192(5):1566-72. doi: 10.1016/j.ajog.2004.11.041.
The purpose of this study was to compare the efficacy of a Mersilene mesh suburethral sling for occult stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with severe vaginal prolapse of the anterior compartment to the posterior/apical compartment.
This was a retrospective study that compared women with stage or grade III/IV prolapse of the anterior compartment (group 1) with the posterior/apical compartment (group 2); both groups demonstrated occult SUI (leakage only with prolapse reduced) and ISD on urodynamics, and underwent concurrent pelvic reconstructive surgery. The sling was defined as efficacious if SUI was prevented in 85% of women and if obstructive symptoms (de novo or worsening urge incontinence, or urinary retention greater than 2 weeks) occurred in less than 10% of women.
There were 39 women in group 1 and 25 women in group 2. There were no differences between women in group 1 or group 2 in preoperative demographics (except parity) or urodynamic findings. SUI cure rates were lower for group 1 than group 2, but this difference was not significant (87% vs 100%, P = .15). Rates of de novo or worsening urge incontinence (8% vs 4%, P = 1.00) and urinary retention (none occurred) were similar between groups.
In women with severe vaginal prolapse, slings effectively treat occult SUI and ISD, whether associated with anterior or posterior/apical prolapse.
本研究旨在比较Mersilene网片尿道下吊带术对重度阴道前壁脱垂合并隐匿性压力性尿失禁（SUI）及固有括约肌缺陷（ISD）的女性与阴道后/顶端脱垂女性的疗效。
这是一项回顾性研究，比较了前壁Ⅲ/Ⅳ度脱垂女性（第1组）与后/顶端脱垂女性（第2组）；两组均表现为隐匿性SUI（仅在脱垂减轻时漏尿）且尿动力学检查显示存在ISD，并同时接受了盆腔重建手术。如果85%的女性预防了SUI，且不到10%的女性出现梗阻性症状（新发或加重的急迫性尿失禁，或尿潴留超过2周），则该吊带被定义为有效。
第1组有39名女性，第2组有25名女性。第1组和第2组女性术前人口统计学特征（除产次外）或尿动力学检查结果无差异。第1组的SUI治愈率低于第2组，但差异无统计学意义（87%对100%，P = 0.15）。两组新发或加重的急迫性尿失禁发生率（8%对4%，P = 1.00）及尿潴留发生率（均未发生）相似。
对于重度阴道脱垂的女性，无论与前壁脱垂还是后/顶端脱垂相关，吊带术均可有效治疗隐匿性SUI和ISD。
