尿道中段悬吊术后膀胱排空不全的危险因素。
Risk factors for incomplete bladder emptying after midurethral sling.
出版信息
Urology. 2013 Nov;82(5):1038-41. doi: 10.1016/j.urology.2013.05.060.
OBJECTIVE
To describe the prevalence and risk factors for incomplete bladder emptying after midurethral slings (MUS) in a large multicenter trial.
METHODS
Five hundred ninety-seven women were randomized to retropubic (RMUS) or transobturator midurethral slings as part of the Trial of MidUrethral Slings study. Demographic data and voiding symptoms were obtained preoperatively along with urodynamics. Patients underwent a standardized voiding trial at discharge after continence surgery. Incomplete bladder emptying was defined as a postvoid residual of >150 mL.
RESULTS
Three-quarters of patients (454 of 597) were self-voiding at discharge, whereas 114 of 597 (19%) were managed with an indwelling urethral catheter and 29 of 597 (5%) with intermittent catheterization. At 2 weeks, only 38 of 586 (6%) reported any catheter use, and by 6 weeks, only 9 of 587 (2%) reported any catheter use. Women with incomplete bladder emptying at discharge were more likely to have had a RMUS (odds ratio 1.79; 95% confidence interval 1.22-2.62) and to report preoperative voiding accommodations such as straining to void (odds ratio 1.75; 95% confidence interval 1.04-2.96). Urodynamic and clinicodemographic parameters were not predictive of incomplete bladder emptying.
CONCLUSION
Incomplete bladder emptying at discharge after MUS is common, especially after RMUS, but of short duration. Risk factors include preoperative voiding accommodations such as straining or bending over to void, but other variables including urodynamics did not predict incomplete bladder emptying after MUS.
目的
描述大型多中心试验中经尿道中段吊带（MUS）后膀胱排空不完全的发生率和危险因素。
方法
597 名女性被随机分配至经耻骨后（RMUS）或经闭孔尿道中段吊带作为 MidUrethral Slings 试验的一部分。术前获取人口统计学数据和排尿症状，并进行尿动力学检查。在 incontinence 手术后出院时，患者接受标准化排尿试验。残余尿量>150ml 定义为膀胱排空不完全。
结果
四分之三的患者（597 例中的 454 例）在出院时自行排尿，而 597 例中有 114 例（19%）留置导尿管，29 例（5%）间歇性导尿。在 2 周时，仅有 38 例（586 例中的 38 例）报告有任何导管使用，在 6 周时，仅有 9 例（587 例中的 9 例）报告有任何导管使用。出院时膀胱排空不完全的女性更有可能接受 RMUS（优势比 1.79；95%置信区间 1.22-2.62），并报告术前排尿适应措施，如用力排尿（优势比 1.75；95%置信区间 1.04-2.96）。尿动力学和临床参数并不能预测膀胱排空不完全。
结论
MUS 后出院时膀胱排空不完全很常见，尤其是 RMUS 后，但持续时间较短。危险因素包括术前排尿适应措施，如用力或弯腰排尿，但其他变量，包括尿动力学，不能预测 MUS 后膀胱排空不完全。
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