Salin Ambroise, Conquy Sophie, Elie Caroline, Touboul Cyril, Parra Jérome, Zerbib Marc, Debré Bernard, Amsellem-Ouazana Delphine
Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Cochin, Department of Urology, Paris, France.
Eur Urol. 2007 Mar;51(3):782-7; discussion 787. doi: 10.1016/j.eururo.2006.10.056. Epub 2006 Nov 3.
To determine preoperative risk factors of postoperative voiding dysfunction after tension-free vaginal tape (TVT) procedure.
In 2004, 100 patients with genuine stress urinary incontinence underwent surgery by the TVT procedure. Preoperative and postoperative urodynamic study was performed for each patient. Postoperatively, patients' perception of result and quality of life were assessed on two validated scales, namely, Mesure du Handicap Urinaire (MHU) and Ditrovie. Voiding dysfunction was defined by a postoperative peak flow rate of <15 ml/s at 3 mo. Clinical and urodynamic parameters were compared and analysed.
At 3 mo, 20 patients (20%) showed evidence of voiding dysfunction despite the absence of clinical symptoms in 14 of them (70%). Multivariate analysis showed that age (p<0.038) and preoperative peak flow rate (p<0.001) were independent risk factors for voiding dysfunction. Parity, menopausal status, body mass index, and maximal urethral closure pressure were not statistically related to the risk of voiding dysfunction.
This study confirms the existence of an important rate of postoperative voiding dysfunction, mostly asymptomatic, and identifies age and preoperative maximal peak flow rate as independent preoperative risk factors. Identification of voiding dysfunction in patients may lead to better follow-up and early detection of late potential complications of suburethral procedures.
确定无张力阴道吊带术（TVT）术后排尿功能障碍的术前危险因素。
2004年，100例真性压力性尿失禁患者接受了TVT手术。对每位患者进行术前和术后尿动力学研究。术后，使用两种经过验证的量表，即尿失禁障碍测量量表（MHU）和Ditrovie量表，评估患者对手术结果的感知和生活质量。排尿功能障碍定义为术后3个月时最大尿流率<15 ml/s。对临床和尿动力学参数进行比较和分析。
术后3个月时，20例患者（20%）出现排尿功能障碍，其中14例（70%）无临床症状。多因素分析显示，年龄（p<0.038）和术前最大尿流率（p<0.001）是排尿功能障碍的独立危险因素。产次、绝经状态、体重指数和最大尿道闭合压与排尿功能障碍风险无统计学关联。
本研究证实术后排尿功能障碍发生率较高，且大多无症状，并确定年龄和术前最大尿流率为独立的术前危险因素。识别患者的排尿功能障碍可能有助于更好地随访并早期发现尿道下手术的潜在晚期并发症。
