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[阴部神经刺激对预测盆腔器官脱垂手术后压力性尿失禁的价值]

[Value of pudendal nerve stimulation for predicting the stress urinary incontinence following pelvic prolapse surgery].

作者信息

Wang A P, Song J, Lyu X L, Chen L M, Zhong X L, Song Y F

机构信息

Department of Obstetrics and Gynecology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2016 Jun 25;51(6):431-5. doi: 10.3760/cma.j.issn.0529-567X.2016.06.006.

Abstract

OBJECTIVE

To seek the predictive value of pudendal nerve function that need preventive anti-incontinence surgery at the same time following pelvic prolapse surgery in severe pelvic organ prolapse (POP) patients.

METHODS

Seventy women completed this study from January 2014 to June 2015 in Fuzhou General Hospital of Nanjing Military Command, dividing into four groups: POP with or without coexisting occult stress urinary incontinence (OSUI) in preoperation, women with persistent stress urinary incontinence (SUI) in postoperation, women without SUI in postoperation. The pudendal nerve function in preoperation was measured by using Solar Urodynamic Neuro Module, including pudendal nerve terminal motor latency (PNTML), and amplitude.

RESULTS

There were statistical significance on bilateral PNTML between POP coexisting OSUI group and only severe POP group [(2.62±0.23) versus (2.40±0.26) ms in right of PNTML, (2.55± 0.21) versus (2.37 ±0.30) ms in left of PNTML; all P<0.05], but no statistical significance on bilateral amplitude (P>0.05). Compared de novo SUI group with POP group in postoperation, de novo SUI group's right of PNTML was significantly increased [(2.74±0.16) versus (2.47±0.26) ms; P< 0.05]; and the right of PNTML was extending 2.5 standard deviation at least compared with the health's [(2.10±0.20) ms].

CONCLUSIONS

The PNTML of pudendal nerve of POP coexisting OSUI is severe than only severe POP, the velocity of nerve conduction is slowing, and PNTML extension has a predictive value for postoperative urinary incontinence. When the right of PNTML of preoperative POP increased by at least 2.5 standard deviations than health's, the risk of SUI postoperative strongly increased, and a anti-incontinence surgery at the same time following pelvic prolapse surgery should be adviced.

摘要

目的

探讨重度盆腔器官脱垂(POP)患者盆腔脱垂手术后同时需要预防性抗尿失禁手术时阴部神经功能的预测价值。

方法

2014年1月至2015年6月,70名女性在南京军区福州总医院完成本研究,分为四组:术前合并或不合并隐匿性压力性尿失禁(OSUI)的POP患者、术后持续性压力性尿失禁(SUI)的女性、术后无SUI的女性。术前使用Solar尿动力学神经模块测量阴部神经功能,包括阴部神经终末运动潜伏期(PNTML)和波幅。

结果

POP合并OSUI组与仅重度POP组双侧PNTML有统计学意义[右侧PNTML分别为(2.62±0.23)与(2.40±0.26)ms,左侧PNTML分别为(2.55±0.21)与(2.37±0.30)ms;均P<0.05],但双侧波幅无统计学意义(P>0.05)。术后新发SUI组与POP组比较,新发SUI组右侧PNTML明显增加[(2.74±0.16)与(2.47±0.26)ms;P<0.05];与健康人相比,右侧PNTML至少延长2.5个标准差[(2.10±0.20)ms]。

结论

POP合并OSUI患者的阴部神经PNTML比仅重度POP患者严重,神经传导速度减慢,PNTML延长对术后尿失禁有预测价值。术前POP患者右侧PNTML比健康人至少增加2.5个标准差时,术后发生SUI的风险显著增加,建议盆腔脱垂手术后同时进行抗尿失禁手术。

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