Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China.
Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Chin Med J (Engl). 2018 Mar 5;131(5):553-558. doi: 10.4103/0366-6999.226057.
The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI.
A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples.
A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ = 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ = 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ = 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05).
No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.
抗失禁手术与脱垂重建联合应用于盆腔器官脱垂（POP）对预防术后尿失禁（UI）的效果仍存在争议。本研究旨在描述盆腔重建术后 UI 的发生率，并评估与 UI 相关的 POP 的治疗方法。
在一家机构中，我们共选取了 329 名于 2009 年 6 月至 2015 年 2 月期间接受全盆腔重建的患者。这些患者被分为两组（A 组[普罗菲尔德重建术]：n=190 例和 B 组[改良全盆腔重建术]：n=139 例）。记录手术过程和患者人口统计学变量的数据。采用卡方检验和学生 t 检验进行两组间的独立样本比较。
术前共有 115 例患者出现 UI。平均随访时间为 46.5 个月，20 例患者失访（6.1%）。压力性尿失禁（SUI）、急迫性尿失禁（UUI）和混合性尿失禁（MUI）的治愈率分别为 51%（30/59）、80%（16/20）和 48%（14/29）。全盆腔重建术后 UUI 的治愈率（80%[16/20]）高于 SUI（50.8%[30/59]，χ=5.219，P=0.03），MUI（48%，14/29）的治愈率最低。术后出现 UI 症状的患者治愈率低于术前（9.1%[28/309] vs. 16.2%[50/309]，χ=7.101，P=0.01）。A 组和 B 组术后 UI 的发生率无差异（P>0.05）。行阴道无张力吊带-闭孔器术的 SUI 患者的治愈率并不高于未行该手术的患者（42.9%[6/14] vs. 53.3%[24/45]，χ=0.469，P=0.49）。两种重建术式的 POP 或 UI 的治愈率无差异（P>0.05）。
UI 的发生率与 POP 无关。结果表明，对于同时患有两种疾病的患者，应在 POP 手术后再进行 UI 治疗。
