Guerette N L, Bena J F, Davila G W
Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jan;19(1):97-102. doi: 10.1007/s00192-007-0393-x. Epub 2007 Jun 5.
The purpose of this study is to evaluate the ability of preoperative urodynamic urethral function parameters to predict the success rate of transobturator slings (TOS). Seventy women urodynamically diagnosed with stress incontinence with urethral hypermobility underwent a Monarc TOS (American Medical Systems, Minnetonka, USA). Postoperative continence status was correlated with preoperative urodynamic urethral function parameters. Mathematical modeling was used to determine whether urodynamic parameters can be used to predict postoperative continence. Average follow-up was 8.1 (6-12) months; 56 (80%) patients were continent based on a standardized stress test and subjective report. The median Valsalva leak point pressure at 150 cc (VLPP150) in the failures and successes was not different (p = 0.12). The median VLPP at cystometric capacity (VLPPcap) in the failures was 32 cmH2O compared to 71 cmH2O in the successes (p < 0.001). The maximum urethral closure pressure (MUCP) had a median of 20 cmH2O in the failures and 45 cmH2O in the successful patients (p < 0.001). No correlation existed between the degree of urethral hypermobility, as measured by the cotton swab test, and surgical success (p = 0.17). There was no correlation between level of preoperative urethral function and persistent overactive bladder symptoms, post-void residual, voids/day, and nocturia. Using a combined model, the cutoff values of VLPPcap > 60 cmH2O and MUCP > 40 cmH2O were the most predictive of surgical success, revealing a sensitivity of 83% (0.55, 0.95) and specificity of 79% (0.67, 0.88). A combination of urodynamic parameters can be used to predict continence rates after a TOS. A TOS should be used with caution in women with impaired urethral function.
本研究的目的是评估术前尿动力学尿道功能参数预测经闭孔吊带术（TOS）成功率的能力。70名经尿动力学诊断为压力性尿失禁且尿道活动过度的女性接受了Monarc TOS（美国美敦力公司，明尼通卡，美国）。术后控尿状态与术前尿动力学尿道功能参数相关。采用数学建模来确定尿动力学参数是否可用于预测术后控尿情况。平均随访时间为8.1（6 - 12）个月；根据标准化压力试验和主观报告，56例（80%）患者实现控尿。失败组和成功组在膀胱容量为150 cc时的最大尿道闭合压（VLPP150）中位数无差异（p = 0.12）。失败组在膀胱测压容量时的最大尿道闭合压（VLPPcap）中位数为32 cmH₂O，而成功组为71 cmH₂O（p < 0.001）。失败组的最大尿道闭合压（MUCP）中位数为20 cmH₂O，成功患者为45 cmH₂O（p < 0.001）。通过棉棒试验测量的尿道活动过度程度与手术成功率之间无相关性（p = 0.17）。术前尿道功能水平与持续性膀胱过度活动症症状、残余尿量、每日排尿次数及夜尿症之间无相关性。使用联合模型，VLPPcap > 60 cmH₂O和MUCP > 40 cmH₂O的临界值对手术成功的预测性最强，敏感性为83%（0.55，0.95），特异性为79%（0.67，0.88）。尿动力学参数的组合可用于预测TOS术后的控尿率。对于尿道功能受损的女性，应谨慎使用TOS。
