Liang Ching-Chung, Tseng Ling-Hong, Chang Yao-Lung, Chang Shuenn-Dhy
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Taiwan J Obstet Gynecol. 2015 Dec;54(6):682-5. doi: 10.1016/j.tjog.2014.08.012.
To investigate the predictors of persistence or resolution of preoperative urgency urinary incontinence (UUI) in women following transvaginal mesh (TVM) repair for advanced pelvic organ prolapse (POP).
Patients with advanced POP undergoing TVM repair between 2008 and 2013 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, voiding diary, pelvic examination using the POP-quantitation system, and urodynamic testing before and after surgery, and intraoperative cystoscopy. Patient demographics, lower urinary tract symptoms, urodynamic findings, and severity of prolapse were analyzed between women with and without preoperative UUI.
Of 174 patients who underwent TVM repair, 49 (28.2%) had preoperative UUI; after operation, 23 (13.2%) were found to have postoperative UUI and 13 (7.5%) developed de novo UUI. For those 49 patients with preoperative UUI, 10 (20.4%) had persistent UUI and 19 (38.8%) developed de novo stress urinary incontinence postoperatively. The prevalence of preoperative bladder outlet obstruction, preoperative maximal cystometric capacity (MCC) < 300 mL, preoperative severe bladder trabeculation, and duration of POP symptoms > 60 months were significantly higher in patients with persistent UUI than without it. Logistic regression demonstrated that preoperative MCC<300 mL, severe bladder trabeculation, and duration of POP symptoms > 60 months were associated with persistent UUI after prolapse repair.
For women with identified preoperative risk factors, including MCC<300 mL, severe bladder trabeculation, and POP symptoms > 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.
探讨晚期盆腔器官脱垂（POP）经阴道网片（TVM）修复术后女性术前急迫性尿失禁（UUI）持续存在或缓解的预测因素。
招募2008年至2013年在一家三级医院接受TVM修复的晚期POP患者。所有患者均接受评估，包括结构化的泌尿妇科问卷、排尿日记、使用POP定量系统进行盆腔检查、手术前后的尿动力学检测以及术中膀胱镜检查。对有和没有术前UUI的女性患者的人口统计学特征、下尿路症状、尿动力学结果和脱垂严重程度进行分析。
在174例行TVM修复的患者中，49例（28.2%）术前有UUI；术后，23例（13.2%）被发现有术后UUI，13例（7.5%）出现新发UUI。对于这49例术前有UUI的患者，10例（20.4%）UUI持续存在，19例（38.8%）术后出现新发压力性尿失禁。UUI持续存在的患者术前膀胱出口梗阻、术前最大膀胱测压容量（MCC）<300 mL、术前严重膀胱小梁形成以及POP症状持续时间>60个月的发生率显著高于无UUI持续存在的患者。逻辑回归显示，术前MCC<300 mL、严重膀胱小梁形成以及POP症状持续时间>60个月与脱垂修复术后UUI持续存在相关。
对于术前已确定存在危险因素的女性，包括MCC<300 mL、严重膀胱小梁形成以及POP症状>60个月，术前咨询应包括讨论TVM修复术后UUI症状持续存在以及新发压力性尿失禁的发生情况。
