Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, ROC.
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Oct;81(10):892-897. doi: 10.1016/j.jcma.2017.11.013. Epub 2018 Feb 17.
To explore the relationship between overactive bladder (OAB) symptoms and paravaginal defects (PVDs), and to identify the necessity of PVD repair by transvaginal mesh (TVM) for the treatment of OAB symptoms.
A retrospective clinical study of 30 women with advanced cystocele with limited apical and posterior vaginal wall prolapse was conducted to identify any changes in OAB symptoms following a single Perigee procedure. Prolapse was assessed using the pelvic organ prolapse quantification (POP-Q) system, and paravaginal defects were identified by sonography. Complete urodynamic examination was performed prior to and one year after operation. All patients completed the overactive bladder questionnaire pre- and postoperatively for a quantitative assessment of OAB symptoms.
All patients showed a significant improvement at points Aa and Ba in the POP-Q system. The results of the administered questionnaire revealed statistically significant improvement postoperatively. The difference of OAB symptoms between the group with PVDs and that with central defects was not statistically significant (p = 0.67). Moreover, no statistically significant improvement of OAB symptoms in the group with repaired PVDs was observed postoperatively (p = 0.42).
Statistical improvements of symptoms exist after Aa and Ba points recovery as evaluated by POP-Q system regardless of PVD existence identified by sonography. Repairing PVD did not show significantly improve the severity of OAB symptoms in objective urodynamic data or subjective questionnaire data. The superiority of TVM in PVD repair to manage OAB symptoms seems not manifest.
探讨膀胱过度活动症（OAB）症状与阴道旁缺陷（PVD）之间的关系，并确定经阴道网片（TVM）修复 PVD 对 OAB 症状治疗的必要性。
对 30 例患有高级膀胱膨出伴有限的阴道顶和后阴道壁脱垂的女性进行回顾性临床研究，以确定单一 Perigee 手术治疗后 OAB 症状的任何变化。脱垂采用盆腔器官脱垂定量（POP-Q）系统进行评估，阴道旁缺陷通过超声检查确定。术前和术后 1 年进行完整的尿动力学检查。所有患者在术前和术后均完成膀胱过度活动症问卷，对 OAB 症状进行定量评估。
所有患者在 POP-Q 系统的 Aa 和 Ba 点均显示出显著改善。问卷调查结果显示术后有统计学意义的改善。存在 PVD 组和存在中央缺陷组之间的 OAB 症状差异无统计学意义（p=0.67）。此外，术后修复 PVD 组的 OAB 症状无统计学意义的改善（p=0.42）。
无论超声检查发现的 PVD 存在与否，POP-Q 系统评估的 Aa 和 Ba 点恢复后都存在症状的统计学改善。修复 PVD 并未在客观尿动力学数据或主观问卷调查数据中显著改善 OAB 症状的严重程度。TVM 在修复 PVD 以管理 OAB 症状方面的优势似乎不明显。
