Department of Reproductive Medicine, University of California San Diego, San Diego, California 92037, USA.
J Urol. 2011 Aug;186(2):597-603. doi: 10.1016/j.juro.2011.03.105. Epub 2011 Jun 16.
We determined whether baseline urodynamic study variables predict failure after mid urethral sling surgery.
Preoperative urodynamic study variables and postoperative continence status were analyzed in women participating in a randomized trial comparing retropubic to transobturator mid urethral sling. Objective failure was defined by positive standardized stress test, 15 ml or greater on 24-hour pad test, or re-treatment for stress urinary incontinence. Subjective failure criteria were self-reported stress symptoms, leakage on 3-day diary or re-treatment for stress urinary incontinence. Logistic regression was used to assess associations between covariates and failure controlling for treatment group and clinical variables. Receiver operator curves were constructed for relationships between objective failure and measures of urethral function.
Objective continence outcomes were available at 12 months for 565 of 597 (95%) women. Treatment failed in 260 women (245 by subjective criteria, 124 by objective criteria). No urodynamic variable was significantly associated with subjective failure on multivariate analysis. Valsalva leak point pressure, maximum urethral closure pressure and urodynamic stress incontinence were the only urodynamic variables consistently associated with objective failure on multivariate analysis. No specific cut point was determined for predicting failure for Valsalva leak point pressure or maximum urethral closure pressure by ROC. The lowest quartile (Valsalva leak point pressure less than 86 cm H2O, maximum urethral closure pressure less than 45 cm H2O) conferred an almost 2-fold increased odds of objective failure regardless of sling route (OR 2.23, 1.20-4.14 for Valsalva leak point pressure and OR 1.88, 1.04-3.41 for maximum urethral closure pressure).
Women with a Valsalva leak point pressure or maximum urethral closure pressure in the lowest quartile are nearly 2-fold more likely to experience stress urinary incontinence 1 year after transobturator or retropubic mid urethral sling.
我们旨在确定基线尿动力学研究变量是否可预测尿道中段吊带术后失败。
对参与一项比较经耻骨后与经闭孔尿道中段吊带的随机试验的女性进行术前尿动力学研究变量和术后控尿状态分析。客观失败定义为阳性标准化压力测试、24 小时垫试验 15ml 或更多，或再次治疗压力性尿失禁。主观失败标准为自我报告的压力症状、3 天日记中有漏尿或再次治疗压力性尿失禁。使用逻辑回归评估协变量与失败之间的关联，同时控制治疗组和临床变量。构建受试者工作特征曲线，以评估客观失败与尿道功能测量之间的关系。
597 例女性中，12 个月时可获得 565 例（95%）的客观控尿结局。260 例女性治疗失败（245 例按主观标准，124 例按客观标准）。多变量分析显示，没有尿动力学变量与主观失败显著相关。Valsalva 漏尿点压、最大尿道闭合压和尿动力学压力性尿失禁是多变量分析中与客观失败唯一一致相关的尿动力学变量。ROC 未确定 Valsalva 漏尿点压或最大尿道闭合压预测失败的特定切点。最低四分位数（Valsalva 漏尿点压<86cmH2O，最大尿道闭合压<45cmH2O）无论吊带途径如何，都使客观失败的可能性增加近 2 倍（Valsalva 漏尿点压的优势比 2.23，1.20-4.14；最大尿道闭合压的优势比 1.88，1.04-3.41）。
Valsalva 漏尿点压或最大尿道闭合压处于最低四分位数的女性，在经闭孔或耻骨后尿道中段吊带 1 年后发生压力性尿失禁的可能性几乎增加 2 倍。
