Bradley Catherine S, Zimmerman M Bridget, Wang Qian, Nygaard Ingrid E
Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
Obstet Gynecol. 2008 May;111(5):1148-53. doi: 10.1097/AOG.0b013e31816a3b96.
To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women.
This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI).
Mean age was 68+/-5 years, BMI 30+/-6 kg/m(2), and median parity 4. Ninety-five percent of women had POP-Q stages I-II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score.
Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I-II prolapse.
II.
确定绝经后女性阴道下移变化是否与盆底症状相关。
这项为期4年的前瞻性研究纳入了在一个妇女健康倡议（WHI）临床试验点招募的260名子宫完整的绝经后女性。所有参与者均完成了至少两次年度盆腔器官脱垂定量（POP-Q）检查和症状问卷（30项膀胱、肠道和脱垂症状条目，改编自盆底困扰量表）。对症状进行分组，并将组评分分为两个或三个均匀分布的水平。由于WHI总体研究停止，第4年的数据收集不完整。使用广义逻辑线性模型和广义估计方程方法来测量阴道下移与症状或症状评分之间的关联，并对时间、年龄和体重指数（BMI）进行控制。
平均年龄为68±5岁，BMI为30±6kg/m²，中位产次为4次。95%的女性有POP-Q I-II期脱垂。最大阴道下移增加与“看到/感觉到肿物”和“突出或肿物感”以及阻塞性膀胱、脱垂和阻塞性肠道评分相关。顶端下移增加（POP-Q点C）与“看到/感觉到肿物”相关，前壁下移增加（POP-Q点Ba）与膀胱疼痛和阻塞性膀胱评分相关，后壁下移增加（POP-Q点Bp）与大便失禁评分相关。
尽管先前的研究表明，大多数盆底症状与早期脱垂程度的相关性较差，但纵向分析表明，在I-II期脱垂的绝经后女性中，随着时间推移阴道下移进展与各种膀胱、肠道和脱垂症状呈正相关。
II级。
