Salerno J, de Tayrac R, Droupy S, Costa P, Llinares E, Fatton B, Wagner L
Service de gynécologie-obstétrique, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
Service de gynécologie-obstétrique, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
Prog Urol. 2016 Jun;26(7):401-8. doi: 10.1016/j.purol.2016.03.003. Epub 2016 Apr 5.
To evaluate the impact of laparoscopic sacrocolpopexy, with or without simultaneous midurethral sling (MUS), on urinary symptoms and health-related quality of life of patients.
A prospective analysis was carried out including 83 women with symptomatic pelvic organ prolapse who had laparoscopic sacrocolpopexy between 2009 and 2011. Patients were classified according to the preoperative clinical examination (stress test). Thirty patients with patent (group A) stress urinary incontinence (SUI) and 15 patients with occult SUI (group B) had a MUS associated with sacrocolpopexy. Thirty-eight patients with negative stress test (group C) were treated by sacrocolpopexy without MUS, even if they had history of SUI. At each visit, urinary symptoms (UDI-6) and their impact on quality of life (UIQ-7) were evaluated using validated self-questionnaires, Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire.
After 3years of mean follow-up, SUI was improved in 22/30 (77%) of patients in group A and only one patient needed a second MUS. Dysuria was cured in 9/12 (75%), 5/7 (71%) and 16/19 (84%) of patients of groups A, B, C respectively and urge urinary incontinence in 13/19 (68%), 2/2 (100%) and 4/6 (67%) of patients. The rate of de novo urge incontinence was respectively 1/11 (9%), 2/13 (15%) and 6/32 (19%). De novo SUI appeared in 6/32 (19%) of patients in group C, but only 2 of them secondarily needed a MUS. After 3 years, our study showed a significant decrease of UDI-6 of 62, 63 and 48% comparing with preoperative score and of UIQ-7 of 77, 54 and 81%.
Laparoscopic sacrocolpopexy associated with MUS for patent stress urinary incontinence improves significantly stress and urgency urinary incontinence. Laparoscopic sacrocolpopexy without MUS, when physical exam shows a negative stress test, significantly reduces voiding difficulties with very few cases of de novo stress and urge incontinence.
评估腹腔镜骶骨阴道固定术（无论是否同时行尿道中段吊带术）对患者泌尿系统症状及健康相关生活质量的影响。
对2009年至2011年间接受腹腔镜骶骨阴道固定术的83例有症状盆腔器官脱垂女性进行前瞻性分析。根据术前临床检查（压力试验）对患者进行分类。30例存在明显压力性尿失禁（SUI）的患者（A组）和15例隐匿性SUI患者（B组）在骶骨阴道固定术同时行尿道中段吊带术（MUS）。38例压力试验阴性的患者（C组），即使有SUI病史，也仅行骶骨阴道固定术而未行MUS。每次随访时，使用经过验证的自填问卷、盆底困扰量表和盆底影响问卷评估泌尿系统症状（UDI-6）及其对生活质量的影响（UIQ-7）。
平均随访3年后，A组22/30（77%）的患者SUI得到改善，仅1例患者需要再次行MUS。A组、B组、C组分别有9/12（75%）、5/7（71%）和16/19（84%）的患者尿痛得到治愈，分别有13/19（68%）、2/2（100%）和4/6（67%）的患者急迫性尿失禁得到改善。新发急迫性尿失禁发生率分别为1/11（9%）、2/13（15%）和6/32（19%）。C组6/32（19%）的患者出现新发SUI，但其中仅2例随后需要行MUS。3年后，我们的研究显示与术前评分相比，UDI-6显著下降了62%、63%和48%，UIQ-7显著下降了77%、54%和81%。
对于明显压力性尿失禁患者，腹腔镜骶骨阴道固定术联合MUS可显著改善压力性和急迫性尿失禁。当体格检查显示压力试验阴性时，未行MUS的腹腔镜骶骨阴道固定术可显著减少排尿困难，新发压力性和急迫性尿失禁的病例极少。
4级
