Matsuoka Priscila Katsumi, Pacetta Aparecida Maria, Baracat Edmund Chada, Haddad Jorge Milhem
Discipline of Gynecology, School of Medicine, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255, 10° andar, Cerqueira César, 05403-000, São Paulo, SP, Brazil,
Int Urogynecol J. 2015 Feb;26(2):187-93. doi: 10.1007/s00192-014-2537-0. Epub 2014 Oct 28.
Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively.
A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ).
Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36).
Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.
患有重度盆腔器官脱垂（POP）的女性在脱垂修复后被认为有发生术后压力性尿失禁（SUI）的风险。患者主观上仍保持控尿的可能解释是POP可导致尿道扭结或受压。我们假设，对于无尿失禁（UI）症状的女性，在手术治疗POP期间进行预防性抗尿失禁手术可能预防术后SUI。
对随机试验进行系统评价。参与者为患有严重POP且无SUI症状的女性。主要结局为手术后的UI或针对该病症的治疗。结果以相对风险（RR）表示，并给出95%置信区间（95%CI）。
最初，通过检索策略识别出5618项研究，但只有7项试验符合纳入标准。我们对研究的共同变量和相同量化尺度进行了荟萃分析。我们发现，在脱垂修复的同时进行抗尿失禁手术可降低术后SUI的发生率（RR 0.51；95%CI 0.38 - 0.68）。然而，当分别分析抗尿失禁手术的类型时，我们得到了不同的结果。接受耻骨后尿道中段吊带手术的患者亚组是唯一从抗尿失禁手术中获益的组，SUI发生率降低（RR 0.09；95%CI 0.02 - 0.36）。
使用耻骨后尿道中段吊带对患有严重POP的女性进行预防性治疗是唯一能降低UI风险 的手术。
