Christmann-Schmid Corina, Bruehlmann Esther, Koerting Isabell, Krebs Joerg
Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland.
Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland.
Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:98-102. doi: 10.1016/j.ejogrb.2018.08.009. Epub 2018 Aug 8.
Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach.
A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery.
A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release.
We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman.
大多数数据支持这样一个事实，即患有症状性盆腔器官脱垂（POP）并伴有症状性或隐匿性压力性尿失禁（SUI）的女性，同时进行POP和抗尿失禁手术会从中受益。然而，一些数据支持延迟或两步法。本研究的目的是证明单纯腹腔镜骶骨阴道固定术（SCP）并采用延迟治疗SUI方法的有效性和安全性，以证明两步法的合理性。
一项2014年至2016年的前瞻性研究，纳入患有症状性POP≥2期脱垂并伴有SUI或隐匿性SUI的女性。对顶端或多部位POP进行腹腔镜SCP，可选择同时或不同时插入无张力尿道中段悬吊带（MUS）。主要观察指标为仅脱垂手术后SUI无症状、持续存在SUI以及后续是否进行抗尿失禁手术。
62名女性仅接受了SCP。仅行SCP的患者中，31%出现压力性尿失禁，其中三分之一的女性因持续性SUI需要额外进行尿道中段悬吊带手术。选择将POP和尿失禁联合手术，即SCP和尿道下悬吊带手术的女性，术后SUI成功率为100%，两名女性需要进行悬吊带松解。
我们发现，患有POP并伴有压力性尿失禁且接受骶骨阴道固定术治疗的女性，采用两步法治疗有益，因为只有11%的患者需要额外进行尿失禁手术。本研究强调了术前咨询的重要性。咨询应根据个体女性进行量身定制。
