Iancu G, Peltecu Gh
Chirurgia (Bucur). 2014 May-Jun;109(3):359-68.
Urodynamics are currently widely used in most of urogynecology services, mainly as a diagnostic tool routinely preoperatively or for complicated cases. The urodynamic parameters, mainly Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP), are increasingly researched for the promising value in predicting the outcome of urinary incontinence surgery. Despite the increasing evidence, their predictive role for mid-urethral sling surgery outcome is still unclear. We systematically searched theliterature for articles published between January 1990 to January 2014, analysing the value of urodynamic variables in predicting the outcome of mid-urethral sling surgery. We calculated relative risks of failure of surgery for patients with low MUCP and VLPP compared with those with high values.Low preoperative MUCP was associated with higher risk of failure for both transobturator and retropubic techniques (RR1.83; 95% confidence interval (CI) 1.44-2.33 and RR 1.41;95% CI 1.17-1.69 respectively). Low preoperative VLPP was predictive as well for higher risk of failure for both transobturator and retropubic routes (RR 1.76; 95% CI 1.37-2.28 and RR 2.01; 95% CI 1.56-2.60 respectively). Concluding, preoperative MUCP and VLPP could be used as predictors for postoperative outcome after mid-urethral sling surgery for SUI.
目前，尿动力学检查在大多数女性盆底重建外科手术中广泛应用，主要作为术前常规诊断工具或用于复杂病例。尿动力学参数，主要是瓦尔萨尔瓦漏尿点压力（VLPP）和最大尿道闭合压（MUCP），在预测尿失禁手术疗效方面的潜在价值正受到越来越多的研究。尽管证据越来越多，但其对尿道中段吊带术手术疗效的预测作用仍不明确。我们系统检索了1990年1月至2014年1月期间发表的文献，分析尿动力学变量在预测尿道中段吊带术手术疗效中的价值。我们计算了低MUCP和VLPP患者与高值患者相比手术失败的相对风险。术前低MUCP与经闭孔和耻骨后技术的较高失败风险相关（RR 1.83；95%置信区间[CI] 1.44 - 2.33和RR 1.41；95% CI 1.17 - 1.69）。术前低VLPP也可预测经闭孔和耻骨后途径的较高失败风险（RR 1.76；95% CI 1.37 - 2.28和RR 2.01；95% CI 1.56 - 2.60）。结论是，术前MUCP和VLPP可作为压力性尿失禁尿道中段吊带术后手术疗效的预测指标。
