Dieter Alexis A, Edenfield Autumn L, Weidner Alison C, Levin Pamela J, Siddiqui Nazema Y
Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive Suite 310, Durham, NC, 27707, USA,
Int Urogynecol J. 2014 Sep;25(9):1269-75. doi: 10.1007/s00192-014-2400-3. Epub 2014 May 9.
Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.
This is a retrospective cohort study of women with bothersome MUI (defined by objective stress test and validated questionnaire) undergoing MUS alone ("MUS-only") or concomitant MUS and AA repair ("MUS + AA"). Our primary outcome was the Overactive Bladder Questionnaire Symptom Severity (OAB-q SS) change score 6 weeks after surgery.
Of 151 women, 67 (44 %) underwent MUS-only and 84 (56 %) underwent MUS + AA. The MUS-only cohort was younger and had less severe baseline prolapse (p < 0.05 for both). Postoperative complications (predominantly UTI) occurred in 35 (23 %) patients and were similar between cohorts. For all subjects mean OAB-q SS scores significantly improved postoperatively (p < 0.05). Our primary outcome, OAB-q SS change score, showed no significant differences between cohorts (30 ± 26 MUS-only vs 25 ± 25 MUS + AA, p = 0.20), indicating similar improvements in OAB symptoms. Multivariate linear regression analysis revealed no difference in OAB-q SS change score between cohorts; however, OAB-q SS change scores were lower for women with a postoperative complication (β = -19, 95 % CI -31 to -6; p < 0.01).
In women with bothersome MUI, concomitant AA repair does not result in additional improvement in OAB symptoms over MUS alone. Patients with postoperative complications exhibit less improvement in OAB symptoms.
中段尿道吊带术（MUS）可改善膀胱过度活动症（OAB）症状。目前尚不清楚修复前壁/顶端脱垂（AA）是否能带来额外益处。我们假设，与单纯行MUS相比，混合性尿失禁（MUI）女性在同期行MUS和AA修复术后，其OAB症状成分会有更大改善。
这是一项回顾性队列研究，研究对象为患有困扰性MUI（通过客观压力测试和有效问卷定义）的女性，她们单独接受MUS（“仅MUS”）或同期接受MUS和AA修复（“MUS + AA”）。我们的主要结局是术后6周膀胱过度活动症问卷症状严重程度（OAB-q SS）变化评分。
151名女性中，67名（44%）仅接受MUS，84名（56%）接受MUS + AA。仅MUS队列的女性更年轻，基线脱垂程度较轻（两者p均<0.05）。35名（23%）患者发生术后并发症（主要为尿路感染），两组之间相似。所有受试者术后OAB-q SS评分均显著改善（p<0.05）。我们的主要结局，即OAB-q SS变化评分，两组之间无显著差异（仅MUS组为30±26，MUS + AA组为25±25，p = 0.20），表明OAB症状改善相似。多变量线性回归分析显示两组之间OAB-q SS变化评分无差异；然而，有术后并发症的女性OAB-q SS变化评分较低（β = -19，95%CI -31至-6；p<0.01）。
对于患有困扰性MUI的女性，同期进行AA修复并不会比单纯MUS在OAB症状方面带来额外改善。有术后并发症的患者OAB症状改善较少。
