LeClaire Edgar L, Mukati Marium S, Juarez Dianna, White Dena, Quiroz Lieschen H
Division Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, 920 S. L. Young, 2430, Oklahoma City, OK, 73104, USA,
Int Urogynecol J. 2014 Sep;25(9):1201-6. doi: 10.1007/s00192-014-2366-1. Epub 2014 Mar 20.
The objective was to investigate the relationship between new onset postoperative stress urinary incontinence (SUI) after sacrocolpopexy (SCP) and anatomical change/surgical approach.
We analyzed a retrospective cohort of patients with negative preoperative testing for SUI who underwent SCP from 2005 to 2012. Our primary outcome was new onset postoperative SUI. Logistic regression was used to examine the relationship among anatomical change, defined as ΔAa, ΔBa, ΔC, and ΔTVL, and surgical approach, categorized as abdominal (ASCP) for open cases and minimally invasive (MISCP) for laparoscopic and robot-assisted cases, and postoperative SUI.
Of 795 cases, 33 ASCP (43%) and 44 MISCP (57%) met the inclusion criteria for analysis. New onset SUI was demonstrated by 15 patients (45%) of the ASCP group and 7 patients (15%) of the MISCP group (p = 0.005). New onset SUI was significantly associated with route of SCP and ΔAa (p = 0.006 and p = 0.033 respectively). Controlling for ΔAa, the odds of new onset SUI were 4.4 times higher in the ASCP group compared with the MISCP group (OR 4.37, 95% CI 1.42, 13.48). Controlling for route of SCP, the odds of new onset SUI were 2.2 times higher with moderate ΔAa compared with low ΔAa (OR 2.16 95% CI 1.07, 4.38). The odds of new onset SUI was 4.7 times higher in those with high ΔAa than in those with low ΔAa (OR 4.67 95% CI 1.14, 19.22). ΔBa, ΔC, and ΔTVL were not associated with new onset SUI.
Greater reduction in point Aa and abdominal surgical route are risk factors for new onset postoperative SUI after SCP.
目的是研究骶骨阴道固定术（SCP）后新发术后压力性尿失禁（SUI）与解剖结构变化/手术方式之间的关系。
我们分析了2005年至2012年接受SCP且术前SUI检测为阴性的患者的回顾性队列。我们的主要结局是术后新发SUI。采用逻辑回归分析解剖结构变化（定义为ΔAa、ΔBa、ΔC和ΔTVL）与手术方式（开放手术为腹部入路（ASCP），腹腔镜和机器人辅助手术为微创入路（MISCP））与术后SUI之间的关系。
795例病例中，33例ASCP（43%）和44例MISCP（57%）符合分析纳入标准。ASCP组15例患者（45%）和MISCP组7例患者（15%）出现新发SUI（p = 0.005）。新发SUI与SCP手术路径和ΔAa显著相关（分别为p = 0.006和p = 0.033）。在控制ΔAa的情况下，ASCP组新发SUI的几率比MISCP组高4.4倍（OR 4.37，95% CI 1.42，13.48）。在控制SCP手术路径的情况下，与低ΔAa相比，中度ΔAa时新发SUI的几率高2.2倍（OR 2.16，95% CI 1.07，4.38）。高ΔAa者新发SUI的几率比低ΔAa者高4.7倍（OR 4.67，95% CI 1.14，19.22）。ΔBa、ΔC和ΔTVL与新发SUI无关。
Aa点更大程度的降低和腹部手术路径是SCP术后新发术后SUI的危险因素。
