Dancz Christina E, Walker Daphne, Thomas Diane, Hussain Nuzhath, Özel Begüm
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 510, Los Angeles, CA, 90033, USA.
, 621 N. Curtis Ave., Alhambra, CA, 91801, USA.
Int Urogynecol J. 2017 Oct;28(10):1589-1593. doi: 10.1007/s00192-017-3289-4. Epub 2017 Mar 3.
The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP).
This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1 cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3 weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher's exact test.
Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3-37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77 days (interquartile range 49-99 days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p = 0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p = 0.003).
Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.
本研究旨在确定晚期盆腔器官脱垂（POP）患者放置子宫托后肾积水改善的女性比例。
这是一项对晚期POP女性肾积水患病率的前瞻性研究的计划子集分析。纳入阴道前壁或顶端脱垂≥1 cm超过处女膜残痕的女性，并对其进行肾积水筛查。所有患者均接受期待治疗、子宫托放置或手术。在研究期间，将自行选择子宫托放置的参与者与接受期待治疗的参与者进行比较。治疗超过3周后进行随访超声检查。使用Fisher精确检验比较显示治愈/改善的参与者比例。
在180名纳入的参与者中，55人患有肾积水，患病率为30.6%（95% CI 24.3-37.6%）。在患有肾积水的患者中，39人（70.8%）选择放置子宫托，16人（30.2%）拒绝。89%的参与者进行了随访超声检查，中位时间为77天（四分位间距49-99天）。意向性分析显示，接受和拒绝子宫托放置的女性在肾积水改善或消退方面没有差异（p = 0.43）。然而，在22名成功使用子宫托的女性中，77.3%显示改善或治愈，而在27名未使用子宫托的女性中这一比例为29.6%（p = 0.003）。
成功使用子宫托使超过75%的晚期POP女性的肾积水得到改善。约39%的脱垂女性未坚持使用子宫托，肾积水未得到改善。
