Fatton B
Urogynecology Unit, Department of Gynecology and Obstetrics, Maternite Hôtel-Dieu, Bd Leon Malfreyt, 63058, Clermont-Ferrand, France.
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Feb;20(2):235-45. doi: 10.1007/s00192-008-0734-4. Epub 2008 Oct 21.
Postoperative SUI prevention at the time of prolapse surgery is still a challenging issue. Recent findings suggested that a systematic prophylactic Burch colposuspension could be performed in continent women undergoing a sacral colpopexy. The aim of this paper is to collect relevant literature in order to suggest a management strategy. A thorough PubMed research of all papers in the English language was conducted. Evidence-based medicine was analyzed and current unanswered questions were discussed. Despite evident limitations, it appears to be some benefit from preoperative screening with a stress test during prolapse reduction. In continent patient with a positive stress test, adding a preventive procedure could be fully justified. In regard to contradictory published data, when negative stress test, patient counseling is important and the ratio of risk-benefit should be rigorously discussed. Further randomized controlled studies are needed to support either a prophylactic or a second-step strategy.
在脱垂手术时预防术后压力性尿失禁仍然是一个具有挑战性的问题。最近的研究结果表明，对于接受骶骨阴道固定术的无尿失禁女性，可以进行系统性预防性Burch阴道悬吊术。本文的目的是收集相关文献，以提出一种管理策略。对所有英文论文进行了全面的PubMed检索。分析了循证医学，并讨论了当前未解决的问题。尽管存在明显的局限性，但在脱垂复位过程中进行压力测试的术前筛查似乎有一定益处。对于压力测试阳性的无尿失禁患者，增加预防性手术是完全合理的。关于已发表的相互矛盾的数据，当压力测试为阴性时，患者咨询很重要，并且应严格讨论风险效益比。需要进一步的随机对照研究来支持预防性或第二步策略。
