Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.
Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Linkou, Taiwan, Republic of China.
Neurourol Urodyn. 2018 Sep;37(7):2242-2248. doi: 10.1002/nau.23576. Epub 2018 Apr 17.
To determine the impact of vaginal pelvic reconstructive surgery (PRS) on detrusor underactivity (DU) patients having advanced pelvic organ prolapse (POP).
A retrospective study of patients who underwent PRS for advanced POP (POP-Q ≥ 3) with DU. Data regarding preoperative evaluation, surgical procedure, and post-operative management were collated. Patients were considered to have DU when detrusor pressure at maximum flow (P Q ) was ≤10 cmH 0 and peak flow rate (Q ) of ≤12 mL/s. Post-operative values more than the cut-off were considered objectively cured. Subjective cure was defined as having a negative response to UDI-6 Question 5, "Do you experience difficulty emptying your bladder?"
A total of 49 patients were evaluated. Majority of the population were post-menopausal and multiparous. Preoperatively, 38 patients (75%) had stage III prolapse and 13 patients (26%) had stage IV. Subjective cure rate of DU was 76% (37/49) and objective cure rate was 47% (23/49). Post-operative DU (P < 0.001) significantly improved together with patients having normal urodynamic diagnosis (P < 0.001). Voiding function showed significant increase in Q (P < 0.001) and P Q (P < 0.001) while PVR (P < 0.001) and cystometric capacity (P < 0.001) significantly decreased. These findings were observed in 89% (43/49) of patients with post-void residual urine (PVR) of <200 mL, 63% (31/49) with Q > 12 mL/s, and 57% (28/49) with P Q >10 cmH 0.
Reversal of short-term or long-term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.
探讨阴道盆底重建术（PRS）对合并中重度盆腔器官脱垂（POP）的逼尿肌活动低下（DU）患者的影响。
对因中重度 POP（POP-Q≥3）行 PRS 且合并 DU 的患者进行回顾性研究。收集患者术前评估、手术方式和术后管理的相关数据。当最大尿流率时逼尿肌压力（P Q ）≤10cmH 0 和最大尿流率（Q ）≤12ml/s 时，患者被认为存在 DU。术后超过临界值者被认为客观治愈。主观治愈定义为尿失禁问卷 -6 项（UDI-6）第 5 项“您是否有排尿困难？”的回答为阴性。
共评估 49 例患者。大多数患者处于绝经后和多产状态。术前 38 例（75%）患者为 3 度脱垂，13 例（26%）患者为 4 度脱垂。DU 的主观治愈率为 76%（37/49），客观治愈率为 47%（23/49）。术后 DU（P<0.001）显著改善，同时患者的尿动力学诊断正常（P<0.001）。排尿功能 Q（P<0.001）和 P Q （P<0.001）显著增加，而 PVR（P<0.001）和膀胱容量（P<0.001）显著减少。这些发现见于 89%（43/49）的残余尿量（PVR）<200ml、63%（31/49）的 Q>12ml/s 和 57%（28/49）的 P Q >10cmH 0 的患者。
阴道盆底重建术通过解除短期或长期梗阻，使膀胱恢复逼尿肌功能。尽管 DU 的客观治愈率为 47%，但如果机械性梗阻是病因，57%的患者逼尿肌功能可恢复。
