Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Obstet Gynecol Scand. 2011 May;90(5):488-93. doi: 10.1111/j.1600-0412.2011.01087.x. Epub 2011 Mar 29.
To locate preoperatively continent women with pelvic organ prolapse at risk of developing incontinence after surgery by means of reducing the prolapse preoperatively with a speculum and a pessary.
Prospective observational cohort study.
Departments of Obstetrics and Gynecology at Northern Alvborgs County Hospital, Varbergs Hospital, and Sahlgrenska University Hospital, Sweden, between 2000 and 2004.
Patients scheduled for anterior wall repair with no history of incontinence.
Data were collected using a questionnaire, a voiding diary, a gynecological examination including staging of prolapse with the Pelvic Organ Quantification System and clinical testing preoperatively and one year after vaginal repair. The first test included a cough test while the prolapse was reduced with a speculum. The second test was performed with the patient undergoing a standardized quantification test and a 48-hour pad test after reducing the prolapse with a pessary. Postoperatively, clinical testing was repeated one year after surgery without any device in place.
Reported symptoms of leakage during movement or coughing.
Seventy-four patients were included. Before surgery, six (8.1%) women tested positive during the speculum test and seven (9.5%) during the pessary test. Eight women (10.8%) were found to have subjective urinary stress incontinence after 1 year. This was only confirmed in four women during stress testing. The positive predictive values for subjective stress incontinence of the speculum and the pessary tests were 42.9% (95%CI 12.0-76.9) and 33.3% (95%CI -4.4 to +71.5), respectively. The negative predictive values of the tests were 92.5% (95%CI 90.3-1.00) and 91.1% (95%CI 88.5-99.7).
The tested preoperative methods predicting de novo subjective stress incontinence after anterior wall repair did not show sufficient positive predictive values to be clinically useful.
通过使用窥器和子宫托术前减少脱垂，定位术前有盆腔器官脱垂但无尿失禁病史的女性患者，这些患者术后有发生尿失禁的风险。
前瞻性观察队列研究。
瑞典北阿尔夫堡县医院、瓦尔贝里医院和萨尔格伦斯卡大学医院的妇产科，时间为 2000 年至 2004 年。
计划接受前壁修补术且无尿失禁病史的患者。
使用问卷、排尿日记、妇科检查（包括盆腔器官定量系统脱垂分期和术前及阴道修补术后 1 年的临床检查）收集数据。第一次检查时，在使用窥器减少脱垂的同时进行咳嗽试验。第二次检查在使用子宫托减少脱垂后，让患者进行标准化定量检查和 48 小时垫试验。术后，在不使用任何器械的情况下，于 1 年后再次进行临床检查。
运动或咳嗽时漏尿的症状报告。
共纳入 74 例患者。术前，6 例（8.1%）患者在窥器检查时呈阳性，7 例（9.5%）患者在子宫托检查时呈阳性。1 年后，8 例（10.8%）患者出现主观尿失禁。仅在 4 例压力测试中证实了这一点。窥器和子宫托检查预测主观压力性尿失禁的阳性预测值分别为 42.9%（95%CI 12.0-76.9）和 33.3%（95%CI -4.4 至 +71.5）。检查的阴性预测值分别为 92.5%（95%CI 90.3-1.00）和 91.1%（95%CI 88.5-99.7）。
术前预测前壁修补术后新发主观压力性尿失禁的方法，其阳性预测值均不充足，无临床应用价值。
