[盆腔脏器脱垂定量分期系统（POP-Q）指示点Aa和Ba，用于隐匿性压力性尿失禁合并盆腔脏器脱垂的诊断及预后评估]

[POP-Q indication points, Aa and Ba, involve in diagnosis and prognosis of occult stress urinary incontinence complicated with pelvic organ prolapse].

作者信息

Liu Cheng, Wu Wenying, Yang Qing, Hu Ming, Zhao Yang, Hong Li

机构信息

Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China.

Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Email:

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2015 Jun;50(6):415-9.

PMID:26311548

Abstract

OBJECTIVE

To investigate the correlation between pelvic organ prolapse quantitation (POP-Q) indication points and the incidence of occult stress urinary incontinence (OSUI) and its impact on prognosis.

METHODS

Retrospective study medical records of 93 patients with pelvic organ prolapse (POP) staged at III-IV, of which underwent pelvic reconstruction operations with Prolift system from Jan. 2007 to Sept. 2012. None of these patients had clinical manifestations of stress urinary incontinence (SUI) before surgery, and in which 44 patients were included in study group (POP complicated with OSUI) because they were identified with OSUI, another 49 patients as control group (simple POP). Follow-up and collecting datas including POP-Q, stress test, urodynamic recordings, incidence of de novo SUI, statistic analyzing by logistic regression and receiver operating characteristic curve (ROC).

RESULTS

(1) The study group had a much higher incidence of 30% (13/44) on de novo SUI than that of control group (4%, 2/49; P < 0.01). (2) Vaginal delivery (OR = 5.327, 95% CI: 1.120-25.347), constipation (OR = 5.789, 95% CI: 1.492-22.459), preoperative OSUI (OR = 13.695, 95% CI: 2.980-62.944), anterior vaginal wall prolapse (OR = 6.115, 95% CI: 1.231-30.379) were identified as dependent risk factors for de novo SUI by logistic regression analysis. (3) For POP patients that complicated with OSUI, we chose a cutoff value of +1.5 cm for Aa point as the threshold to predicting incidence of de novo SUI according to ROC curve, area under the curve (AUC) was 0.889 (P < 0.05), the sensitivity reached 88.9% and specificity was 73.9%. According to ROC curve of Ba point, a cutoff value of +2.5 cm was chosen as the threshold to predicting incidence of de novo SUI post-operation, it had a sensitivity of 66.7% and specificity of 82.6%, AUC was 0.766 (P < 0.05).

CONCLUSIONS

Pre-operative OSUI is a dependent risk factor of de novo SUI for advanced POP patients. Aa and Ba points are correlated with preoperative OSUI, and it is worthy to be considered as a risk predictor on forecasting the incidence of de novo SUI post pelvic reconstruction surgery.

摘要

目的

探讨盆腔器官脱垂定量分期（POP-Q）指示点与隐匿性压力性尿失禁（OSUI）发生率之间的相关性及其对预后的影响。

方法

回顾性研究93例III-IV期盆腔器官脱垂（POP）患者的病历，这些患者于2007年1月至2012年9月接受了Prolift系统盆腔重建手术。所有患者术前均无压力性尿失禁（SUI）的临床表现，其中44例因确诊为OSUI而纳入研究组（POP合并OSUI），另外49例作为对照组（单纯POP）。进行随访并收集包括POP-Q、压力试验、尿动力学记录、新发SUI发生率等数据，采用逻辑回归和受试者操作特征曲线（ROC）进行统计分析。

结果

（1）研究组新发SUI发生率为30%（13/44），显著高于对照组（4%，2/49；P<0.01）。（2）经逻辑回归分析，阴道分娩（OR = 5.327，95%CI：1.120 - 25.347）、便秘（OR = 5.789，95%CI：1.492 - 22.459）、术前OSUI（OR = 13.695，95%CI：2.980 - 62.944）、阴道前壁脱垂（OR = 6.115，95%CI：1.231 - 30.379）被确定为新发SUI的独立危险因素。（3）对于合并OSUI的POP患者，根据ROC曲线，选择Aa点+1.5 cm作为预测术后新发SUI发生率的阈值，曲线下面积（AUC）为0.889（P<0.05），敏感性达88.9%，特异性为73.9%。根据Ba点的ROC曲线，选择+2.5 cm作为预测术后新发SUI发生率的阈值，敏感性为66.7%，特异性为82.6%，AUC为0.766（P<0.05）。