Ennemoser Stefanie, Schönfeld Mirjam, von Bodungen Vera, Dian Darius, Friese Klaus, Jundt Katharina
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU - Innenstadt, Maistr. 11, 80337 Munich, Germany.
Int Urogynecol J. 2012 Jul;23(7):851-5. doi: 10.1007/s00192-012-1765-4. Epub 2012 May 12.
Patients with genital prolapse and occult stress urinary incontinence (OSUI) are typically treated with prolapse surgery and anti-incontinence surgery based on either a one-step approach or a two-step approach. The aim of our study was to determine whether anti-incontinence surgery is necessary based on the occurrence of OSUI in a study cohort with a long follow-up period.
Prolapse surgery was performed using a vaginal approach. Preoperatively, a stress test, a pad test and an assessment of the urodynamics were performed with and without prolapse reduction. Over a follow-up period of 2-8 years, the patients with preoperative evidence of OSUI underwent urogynaecological examinations, stress tests and pad tests.
Of 113 patients with preoperative evidence of OSUI, 57 (50.4 %) were followed up for an average of 5.7 years (range 2-8) after prolapse surgery. Of 57 patients, 16 (28.1 %) had objective and/or subjective stress urinary incontinence (SUI) during the follow-up period, but only 3 patients (5.3 %) required subsequent tension-free vaginal tape (TVT) surgery. In 17 of 57 patients (29.8 %), prolapse recurred.
Despite the preoperative evidence of OSUI, the manifestation of SUI rarely occurs, with 28.1 % of patients experiencing SUI over long-term follow-up after vaginal prolapse surgery. Anti-incontinence surgery was necessary in only three cases (5.3 %). These results indicate that with the one-step approach, 54 of 57 patients (94.7 %) would have received prophylactic anti-incontinence surgery unnecessarily. In conclusion, we recommend the two-step approach in the management of vaginal prolapse surgery in patients with OSUI.
患有生殖器脱垂和隐匿性压力性尿失禁（OSUI）的患者通常根据一步法或两步法接受脱垂手术和抗失禁手术。我们研究的目的是在一个长期随访的研究队列中，根据OSUI的发生情况确定抗失禁手术是否必要。
采用阴道入路进行脱垂手术。术前，在脱垂复位前后分别进行压力试验、尿垫试验和尿动力学评估。在2至8年的随访期内，术前有OSUI证据的患者接受了泌尿妇科检查、压力试验和尿垫试验。
113例术前有OSUI证据的患者中，57例（50.4%）在脱垂手术后平均随访5.7年（范围2至8年）。在这57例患者中，16例（28.1%）在随访期间出现客观和/或主观压力性尿失禁（SUI），但只有3例（5.3%）需要后续的无张力阴道吊带（TVT）手术。57例患者中有17例（29.8%）出现脱垂复发。
尽管术前有OSUI证据，但SUI很少发生，28.1%的患者在阴道脱垂手术后的长期随访中出现SUI。仅3例（5.3%）需要抗失禁手术。这些结果表明，采用一步法时，57例患者中有54例（94.7%）会不必要地接受预防性抗失禁手术。总之，我们建议对患有OSUI的患者采用两步法进行阴道脱垂手术治疗。
