I. Department of Obstetrics and Gynecology, Beckenbodenzentrum der LMU, Ludwig-Maximilians-Universität, Munich, Germany.
Eur J Med Res. 2010 Mar 30;15(3):112-6. doi: 10.1186/2047-783x-15-3-112.
Many surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery.
233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed.
19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape.
The incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.
许多外科医生在患有隐匿性压力性尿失禁的女性中进行脱垂手术时会同时进行抗失禁手术。另一些医生则更喜欢两步走的方法。本研究旨在确定有多少女性真正需要进行第二次手术，以及脱垂减轻时咳嗽压力测试阳性是否与脱垂手术后压力性尿失禁的发展有关。
233 名女性因原发性或复发性脱垂而接受手术，且无 SUI 症状。术前，53/233 名女性进行了完整的妇科泌尿科检查，脱垂已减轻。如果患者出现压力性尿失禁，术后将进行抗失禁手术。
19/53（35.8%）名术前脱垂减轻时行压力测试的女性被定义为隐匿性压力性尿失禁。这 19 名女性中仅有 3 名（15.8%）出现脱垂手术后尿失禁症状，需要因此进行手术。18/233（7.7%）名女性在术后 6 周到 6 个月出现 SUI 症状，接受了 TVT-tape 治疗。
本研究中脱垂手术后出现压力性尿失禁的发生率较低（7.7%）。这一事实以及失禁手术可能产生的严重副作用证明，如果对患者进行了咨询并获得了其同意，两步走的方法是合理的。然而，仍有一小部分女性（3/19，15.8%）在术前存在 OSUI 和术后 SUI，她们可能受益于一步走的方法。需要进一步的研究来确定这些女性，以便在手术干预前对其进行识别。
