Panayi D C, Duckett J, Digesu G A, Camarata M, Basu M, Khullar V
Department of Urogynaecology, St. Mary's Hospital, London, United Kingdom.
Neurourol Urodyn. 2009;28(1):82-5. doi: 10.1002/nau.20576.
To determine if specific pre-operative urodynamic parameters could predict detrusor overactivity following TVT in patients with urodynamic mixed incontinence.
Notes of women with detrusor overactivity (DO) and urodynamic stress incontinence (USI) before undergoing tension-free vaginal tape (TVT) surgery were retrospectively reviewed. Patients underwent clinical evaluation pre-operatively including history, examination, and conventional urodynamic studies and were treated with pelvic floor exercises and anti-cholinergic medication. Those with persistent stress urinary incontinence (SUI) underwent TVT. Patients were re-assessed after at least 6 months post-operatively. Pre- and post-operative opening and closing detrusor pressure, and detrusor pressure at maximum flow were recorded retrospectively from pre-operative urodynamics traces by two clinicians independently and compared to the patients' post-operative symptoms and urodynamic diagnosis.
Fifty-one women were reviewed. Forty-six of the 51 attended follow-up and 35/51 agreed to conventional urodynamic studies. Seventeen of the 35 reported OAB symptoms, and 18/35 were asymptomatic. Nineteen of the 35 women had DO and 16/35 had normal urodynamic studies (NUDS). The median pre-operative opening detrusor pressure was higher in women with overactive bladder symptoms post-operatively. The median pre-operative opening detrusor pressure in women with DO post-operatively was 33.0 cmH(2)O and the median pre-operative opening detrusor pressure in those with NUDS post-operatively was 16 cmH(2)O (15.0-23.0 cmH(2)O) (P < 0.05 Mann-Whitney U-test).
Higher numbers of patients are required to demonstrate the value of opening detrusor pressure in predicting post-operative overactive bladder symptoms. Opening detrusor pressure is predictive of post-operative DO after TVT.
确定在尿动力学混合型尿失禁患者中,特定的术前尿动力学参数是否能够预测经阴道无张力尿道中段吊带术(TVT)后逼尿肌过度活动。
对在接受无张力阴道吊带(TVT)手术前存在逼尿肌过度活动(DO)和尿动力学压力性尿失禁(USI)的女性患者病历进行回顾性分析。患者术前接受临床评估,包括病史、检查和传统尿动力学研究,并接受盆底肌锻炼和抗胆碱能药物治疗。那些持续性压力性尿失禁(SUI)患者接受TVT手术。术后至少6个月对患者进行重新评估。两名临床医生独立地从术前尿动力学记录中回顾性记录术前和术后的逼尿肌开放和关闭压力以及最大尿流率时的逼尿肌压力,并与患者术后症状和尿动力学诊断结果进行比较。
共回顾了51名女性患者。51名患者中有46名参加了随访,51名中有35名同意进行传统尿动力学研究。35名患者中有17名报告有膀胱过度活动症(OAB)症状,18/35名无症状。35名女性中有19名存在DO,16/35名尿动力学研究正常(NUDS)。术后有膀胱过度活动症状的女性术前逼尿肌开放压力中位数较高。术后有DO的女性术前逼尿肌开放压力中位数为33.0 cmH₂O,术后有NUDS的女性术前逼尿肌开放压力中位数为16 cmH₂O(15.0 - 23.0 cmH₂O)(曼-惠特尼U检验,P < 0.05)。
需要更多患者来证明逼尿肌开放压力在预测术后膀胱过度活动症状方面的价值。逼尿肌开放压力可预测TVT术后的DO。