Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
Acta Obstet Gynecol Scand. 2018 Jun;97(6):744-750. doi: 10.1111/aogs.13337. Epub 2018 Apr 4.
To date sacrocolpopexy is regarded as the reference standard treatment for primarily apical compartment prolapse and multicompartment prolapse. Most bladder and bowel dysfunction improves postoperatively after sacrocolpopexy; however, de novo bowel or de novo bladder dysfunction can occur. The inferior hypogastric nerve is commonly known among pelvic surgeons. However, the inferior hypogastric nerve and its fine fibers are difficult to identify; iatrogenic lesion is commonly tolerated although this can lead to bladder, bowel and sexual dysfunction. This study was performed to assess the functional outcome after nerve-sparing sacrocolpopexy.
From 2014 to 2016 all women undergoing a laparoscopic sacrocolpopexy for apical or multicompartment prolapse stage >2 were included in this prospective study. Laparoscopic sacrocolpopexy was performed using the nerve-sparing approach. Objective outcome was assessed by preoperative and postoperative POP-Q changes. De novo bladder and de novo bowel dysfunction were subjectively and objectively evaluated.
In all, 137 women were included. Significant objective improvement for point Aa and C (p < 0.0001) preoperatively to postoperatively was seen. The posterior compartment remained unchanged with point Ba -2. De novo overactive bladder and de novo bladder outlet obstruction with elevated postresidual volume were seen for both in 0.7% (1/137). De novo stress urinary incontinence was seen in 0.7% (5/137). De novo constipation was seen in 5%, bowel incontinence in 0% and resolution of pre-existing obstipation in 14.5%. De novo laxative use (9%) in the first 12 weeks was the most common postoperative problem.
We could demonstrate that when a nerve-sparing technique is applied for sacrocolpopexy low de novo bladder (18%) and de novo bowel dysfunction can be seen.
迄今为止，骶骨阴道固定术被认为是治疗主要顶部腔室脱垂和多腔室脱垂的参考标准治疗方法。大多数膀胱和肠功能障碍在骶骨阴道固定术后会得到改善；然而，新出现的肠道或新出现的膀胱功能障碍可能会发生。下腹下神经在盆腔外科医生中广为人知。然而，下腹下神经及其细纤维难以识别；虽然这可能导致膀胱、肠道和性功能障碍，但医源性损伤通常可以耐受。本研究旨在评估保留神经的骶骨阴道固定术后的功能结果。
从 2014 年到 2016 年，所有因顶部或多腔室脱垂>2 期而接受腹腔镜骶骨阴道固定术的女性均纳入本前瞻性研究。腹腔镜骶骨阴道固定术采用保留神经的方法进行。通过术前和术后 POP-Q 变化评估客观结果。新出现的膀胱和新出现的肠道功能障碍进行了主观和客观评估。
共纳入 137 名女性。术前 Aa 和 C 点（p<0.0001）有显著的客观改善。后腔室保持不变，Ba-2 点不变。0.7%（1/137）的患者出现新的逼尿肌过度活动和新的膀胱出口梗阻伴残余尿量升高。0.7%（5/137）的患者出现新的压力性尿失禁。新发便秘 5%，肠失禁 0%，原有便秘缓解 14.5%。术后 12 周内最常见的术后问题是新出现的需要使用泻药（9%）。
当骶骨阴道固定术采用保留神经的技术时，我们可以发现新出现的膀胱（18%）和肠道功能障碍较低。
