Ballert Katie N, Biggs Grace Y, Isenalumhe Anthony, Rosenblum Nirit, Nitti Victor W
Department of Urology, New York University, New York, New York 10016, USA.
J Urol. 2009 Feb;181(2):679-84. doi: 10.1016/j.juro.2008.10.009. Epub 2008 Dec 16.
We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair.
A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction.
The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%.
Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.
我们评估了用于确定在经阴道盆腔器官脱垂修复术中是否放置尿道中段合成吊带的方案。
共有140例患者接受了2至4期盆腔器官脱垂的经阴道修复术，其中105例按照该方案进行治疗，且至少随访3个月或需要更早进行干预。在未减轻脱垂的情况下进行尿动力学检查。当未发现压力性尿失禁时，放置子宫托并重复检查。患者被分为存在尿动力学性、隐匿性或无压力性尿失禁。存在尿动力学性或隐匿性压力性尿失禁的患者同时接受尿道中段合成吊带手术，而不存在尿动力学性或隐匿性压力性尿失禁的患者则不进行该手术。查阅病历以确定是否需要针对压力性尿失禁或梗阻进行进一步干预。
接受尿道中段合成吊带后因梗阻而进行干预的风险为8.5%。无临床、尿动力学性或隐匿性压力性尿失禁且未接受尿道中段合成吊带的患者因压力性尿失禁而进行干预的风险为8.3%。有临床压力性尿失禁但无尿动力学性或隐匿性压力性尿失禁且未接受尿道中段吊带的患者因压力性尿失禁而进行干预的风险为30%。
在经阴道盆腔器官脱垂修复术中使用我们的尿动力学方案来处理尿道，当不存在临床、尿动力学性或隐匿性压力性尿失禁且未放置尿道中段合成吊带时，因梗阻而进行干预的风险基本等同于因压力性尿失禁而进行干预的风险。在术前报告有临床压力性尿失禁但无尿动力学性或隐匿性压力性尿失禁的患者中，因压力性尿失禁而进行进一步干预的发生率要高得多。
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