Bradley Catherine S, Nygaard Ingrid E
Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
Obstet Gynecol. 2005 Oct;106(4):759-66. doi: 10.1097/01.AOG.0000180183.03897.72.
To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms.
In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus.
Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and feeling a bulge were associated with vaginal descensus. Obstructive urinary symptom scores increased as anterior (P = .04), posterior (P < .01), and maximal (P = .01) vaginal descensus increased. Urinary incontinence or bowel symptoms were not associated with descensus of any vaginal compartment. ''See or feel a bulge,'' reported by 11 women (4%), was associated with descensus in all compartments (P < or = .04 for all) and with prolapse at or beyond the hymen (P < .001). This symptom was specific (100%), but not sensitive (16%) for prolapse, defined as descensus at or beyond the hymen.
Vaginal support defects in older women are associated with obstructive urinary symptoms and the symptom of seeing or feeling a bulge. However, symptoms are not useful in discriminating between women with and without milder vaginal wall descensus. Based on these results, we suggest that other etiologies for bothersome bladder or bowel complaints be considered before performing surgery for early pelvic organ prolapse.
为了解老年女性早期盆腔器官脱垂的临床意义，我们研究了阴道下移与盆底症状之间的关联。
在这项横断面研究中，270名参与妇女健康倡议临床试验一个站点的女性完成了一份根据盆底困扰量表修改的关于盆底症状的问卷，并接受了盆腔器官脱垂定量（POP-Q）检查。我们测试了（个体及分组的）症状与前壁、后壁、子宫及最大阴道下移之间的关联。
平均年龄为68岁。96%的女性处于POP-Q I期或II期。仅梗阻性尿路症状和感觉有肿物膨出与阴道下移有关。随着前壁（P = 0.04）、后壁（P < 0.01）及最大（P = 0.01）阴道下移增加，梗阻性尿路症状评分升高。尿失禁或肠道症状与任何阴道腔室的下移均无关联。11名女性（4%）报告的“看到或感觉到肿物膨出”与所有腔室的下移有关（所有P≤0.04），且与处女膜处或其上方的脱垂有关（P < 0.001）。该症状对于定义为处女膜处或其上方下移的脱垂具有特异性（100%），但不具有敏感性（16%）。
老年女性的阴道支持缺陷与梗阻性尿路症状以及看到或感觉到肿物膨出的症状有关。然而，这些症状对于区分有无较轻阴道壁下移的女性并无帮助。基于这些结果，我们建议在对早期盆腔器官脱垂进行手术之前，应考虑膀胱或肠道不适的其他病因。
