Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Urol. 2010 Mar;183(3):1069-73. doi: 10.1016/j.juro.2009.11.025. Epub 2010 Jan 21.
We determined the relevance of the biomechanical properties of freshly harvested vaginal tissue during large cystocele repair on clinical outcome at a minimum 1-year followup.
With institutional review board approval we prospectively studied the biomechanical properties of full thickness vaginal wall tissue from postmenopausal women with symptomatic Baden-Walker prolapse undergoing anterior vaginal wall suspension with cystocele repair from 2002 to 2005. A standardized biomechanical protocol was applied with stress-strain curves for Young's modulus obtained by blinded investigators. Failed repair was defined as recurrence on examination or reoperation for recurrent anterior prolapse.
A total of 32 patients (median age 72 years) had a median followup of 34 months (range 12 to 62). Median Young's modulus was statistically different in tissue samples transported in immersed vs moistened media (median 3.8 vs 7.6, p = 0.008). Associations between Young's modulus and clinical variables were described. On followup 7 patients experienced failure of the repair. After controlling for tissue transport protocol no association was seen between Young's modulus and failures (HR 1.1, p = 0.34).
This study found no association between Young's modulus and clinical results at long-term followup. This finding suggests that retropubic scarring and pelvic floor muscle properties may be more important for a successful reparative outcome than the intrinsic properties of the vaginal wall.
我们确定了在接受大型膀胱膨出修复术的绝经后妇女中，新鲜收获的阴道组织的生物力学特性与至少 1 年随访时的临床结果的相关性。
经机构审查委员会批准，我们前瞻性研究了 2002 年至 2005 年间患有有症状 Baden-Walker 脱垂的绝经后妇女的全层阴道壁组织的生物力学特性，这些妇女接受了前阴道壁悬吊术和膀胱膨出修复术。应用标准化生物力学方案，由盲法研究人员获得杨氏模量的应力-应变曲线。修复失败定义为检查时复发或因前位复发而再次手术。
共有 32 名患者（中位年龄 72 岁）中位随访 34 个月（范围 12 至 62）。在浸入和湿润介质中运输的组织样本中，杨氏模量的中位数存在统计学差异（中位数 3.8 对 7.6，p = 0.008）。描述了杨氏模量与临床变量之间的关系。随访时，7 名患者的修复失败。在控制组织运输方案后，杨氏模量与失败之间未见关联（HR 1.1，p = 0.34）。
本研究未发现杨氏模量与长期随访时的临床结果之间存在关联。这一发现表明，耻骨后瘢痕和盆底肌肉特性对于修复成功的结果可能比阴道壁的固有特性更为重要。
