Viereck Volker, Pauer Hans-Ulrich, Hesse Oda, Bader Werner, Tunn Ralf, Lange Rainer, Hilgers Reinhard, Emons Günter
Department of Gynecology and Obstetrics, Georg August University Goettingen, Goettingen, Germany.
Int Urogynecol J Pelvic Floor Dysfunct. 2006 Nov;17(6):586-92. doi: 10.1007/s00192-006-0071-4. Epub 2006 Mar 15.
The aim of this study was to define the concept of hypermobility of the bladder neck and determine its effects on the cure rate and postoperative complications in patients undergoing colposuspension. In a retrospective study, 310 patients who underwent primary colposuspension for urodynamically proven genuine stress urinary incontinence were assessed by introital ultrasound before surgery and during follow-up for up to 48 months postoperatively. A total of 152 women completed 48 months of follow-up. Mobility of the bladder neck during straining was described as linear dorsocaudal movement (LDM) with LDM >15 mm being defined as hypermobility. The overall objective cure rate was 90.0% at 6-month follow-up vs 76.8% at 48-month follow-up (Kaplan-Meier estimators). Urge symptoms occurred in 12.6% (39/310) of the women and de novo urge incontinence in 2.3% (7/310). Bladder neck hypermobility was significantly reduced after anti-incontinence surgery, from 67.1% (208/310) before surgery to 5.5% (17/310) immediately after surgery (P<0.0001). Postoperative hypermobility was associated with a higher recurrence rate. In the hypermobility group, 52.9 and 34.0% of the patients were continent for up to 6 and 48 months, respectively, as opposed to 92.2 and 79.2% in the group without hypermobility (P<0.0001). Women with postoperative hypermobility had a 3.2-fold higher risk of recurrence within 48 months. Bladder neck hypermobility after surgery was also associated with postoperative voiding difficulty (P=0.0278). Patients in whom hypermobility of the bladder neck diagnosed before surgery persists after colposuspension have a higher risk of recurrence and are more likely to develop postoperative complications than those without this hypermobility.
本研究的目的是明确膀胱颈活动度过高的概念，并确定其对接受阴道前壁悬吊术患者治愈率和术后并发症的影响。在一项回顾性研究中，对310例因尿动力学证实为真性压力性尿失禁而接受初次阴道前壁悬吊术的患者，在手术前及术后长达48个月的随访期间通过阴道超声进行评估。共有152名女性完成了48个月的随访。用力时膀胱颈的活动度被描述为线性背尾侧移动（LDM），LDM>15mm被定义为活动度过高。6个月随访时总体客观治愈率为90.0%，而48个月随访时为76.8%（Kaplan-Meier估计值）。12.6%（39/310）的女性出现尿急症状，2.3%（7/310）出现新发尿急失禁。抗尿失禁手术后膀胱颈活动度过高显著降低，从术前的67.1%（208/310）降至术后即刻的5.5%（17/310）（P<0.0001）。术后活动度过高与较高的复发率相关。在活动度过高组中，分别有52.9%和34.0%的患者在6个月和48个月时仍保持控尿，而无活动度过高组分别为92.2%和79.2%（P<0.0001）。术后活动度过高的女性在48个月内复发风险高3.2倍。术后膀胱颈活动度过高还与术后排尿困难相关（P=0.0278）。与无这种活动度过高的患者相比，术前诊断为膀胱颈活动度过高且在阴道前壁悬吊术后持续存在的患者复发风险更高，且更易发生术后并发症。
