Choe Jin Ho, Choo Myung-Soo, Lee Kyu-Sung
Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul Korea.
J Urol. 2008 Jan;179(1):214-9. doi: 10.1016/j.juro.2007.08.151. Epub 2007 Nov 14.
We assessed the impact of the tension-free vaginal tape procedure on overactive bladder in women with stress urinary incontinence to determine the change in preoperative overactive bladder symptoms and the significance of detrusor overactivity in postoperative outcomes.
From January 2003 to December 2004 a total of 549 consecutive women with stress urinary incontinence underwent the tension-free vaginal tape procedure. Of these patients 180 (32.8%) had overactive bladder syndrome. Finally 132 women (mean age 53.2 years) with followup of at least 3 months were included in analysis. Patients with the overactive bladder syndrome with or without detrusor overactivity based on urodynamic study were subdivided into 94 (71.2%) patients with the overactive bladder syndrome without detrusor overactivity and 38 (28.8%) with the overactive bladder syndrome with detrusor overactivity.
The complete resolution of all overactive bladder symptoms based on 3-day frequency volume chart and a validated questionnaire was demonstrated in 23.5% (31 of 132 patients). The detrusor overactivity present group showed significantly greater urinary leakage per 1-hour pad test, maximal detrusor pressure and detrusor pressure at maximal flow rate than the detrusor overactivity absent group. There was no significant difference in the 2 groups in terms of cure rate for stress urinary incontinence. The detrusor overactivity present group had a significantly higher resolution rate than the detrusor overactivity absent group for overactive bladder (36.8 vs 18.1 %, p = 0.021).
The tension-free vaginal tape procedure can be performed in women with stress urinary incontinence and overactive bladder including urge incontinence even if the patient has detrusor overactivity on urodynamic study. However, patients should be fully advised of the possibility of persistent overactive bladder symptoms and treatment for those symptoms after tension-free vaginal tape should be considered.
我们评估了无张力阴道吊带术对压力性尿失禁女性膀胱过度活动症的影响，以确定术前膀胱过度活动症症状的变化以及逼尿肌过度活动在术后结果中的意义。
2003年1月至2004年12月，共有549例连续性压力性尿失禁女性接受了无张力阴道吊带术。其中180例（32.8%）患有膀胱过度活动症。最终，132例女性（平均年龄53.2岁）纳入分析，其随访时间至少为3个月。根据尿动力学研究，将患有或未患有逼尿肌过度活动的膀胱过度活动症患者分为94例（71.2%）无逼尿肌过度活动的膀胱过度活动症患者和38例（28.8%）有逼尿肌过度活动的膀胱过度活动症患者。
根据3天频率 - 尿量图表和一份经过验证的问卷，所有膀胱过度活动症症状完全缓解的情况在132例患者中有23.5%（31例）得到证实。存在逼尿肌过度活动组在每1小时护垫试验中的尿失禁量、最大逼尿肌压力和最大尿流率时的逼尿肌压力均显著高于无逼尿肌过度活动组。两组在压力性尿失禁治愈率方面无显著差异。存在逼尿肌过度活动组膀胱过度活动症的缓解率显著高于无逼尿肌过度活动组（36.8%对18.1%，p = 0.021）。
对于压力性尿失禁合并膀胱过度活动症包括急迫性尿失禁的女性，即使患者在尿动力学研究中有逼尿肌过度活动，也可进行无张力阴道吊带术。然而，应充分告知患者术后可能持续存在膀胱过度活动症症状，并应考虑对这些症状进行治疗。
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