Dengler Erin G, Mounsey Louisa A, Gines Francesca, Agha Manahil, Long Terri, Geller Elizabeth J
School of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St., Chapel Hill, NC, 27516, USA.
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Int Urogynecol J. 2019 Jul;30(7):1111-1116. doi: 10.1007/s00192-018-3777-1. Epub 2018 Oct 20.
Pessaries provide first-line therapy for women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The primary hypothesis was that defecatory dysfunction was associated with pessary discontinuation.
This was a retrospective cohort study of all women undergoing first pessary placement at one academic center from April 2014 to January 2017. Defecatory dysfunction was defined as the presence of constipation, rectal straining, rectal splinting, and/or incomplete defecation. Pessary discontinuation was defined as <1 year of pessary use and not using one at the most recent visit. Descriptive statistics; Person's chi-square, Fisher's exact, and Student's t test, and multivariate logistic regression analysis were used where appropriate.
Charts of 1092 women were reviewed and 1071 were included. Mean age was 62 ± 15 years, mean body mass index (BMI) 28 ± 6 kg/m, and mean parity 2 ± 1; 68% were Caucasian, 73% were menopausal, and 41% were sexually active. Reason for pessary use included POP (46%), SUI (24%), or both (30%). Overall pessary discontinuation rate was 77%; overall rate of defecatory dysfunction was 45%. In a logistic regression model, defecatory dysfunction in the form of incomplete defecation remained significantly associated with pessary discontinuation [odds ratio (OR) 3.29, 95% confidence interval (CI) 1.43-7.52]. Absence of bulge symptoms (OR 2.18, 95% CI 1.22-3.90), and younger age (OR 1.02, 95% CI 1.02-1.05) also remained significantly associated with pessary discontinuation.
Pessary discontinuation was common, and defecatory dysfunction in the form of incomplete defecation had the strongest association with discontinuation. Understanding predictive factors of pessary discontinuation may help guide clinicians and patients when choosing treatment options for pelvic floor dysfunction.
子宫托为盆腔器官脱垂（POP）和压力性尿失禁（SUI）女性提供一线治疗。主要假设是排便功能障碍与子宫托停用有关。
这是一项对2014年4月至2017年1月在一个学术中心首次放置子宫托的所有女性进行的回顾性队列研究。排便功能障碍定义为存在便秘、直肠用力、直肠支撑和/或排便不完全。子宫托停用定义为子宫托使用时间<1年且在最近一次就诊时未使用。采用描述性统计；在适当情况下使用Pearson卡方检验、Fisher精确检验、Student t检验和多因素逻辑回归分析。
对1092名女性的病历进行了审查，纳入了1071名。平均年龄为62±15岁，平均体重指数（BMI）为28±6kg/m²，平均产次为2±1；68%为白种人，73%处于绝经状态，41%有性生活。使用子宫托的原因包括POP（46%）、SUI（24%）或两者皆有（30%）。子宫托总体停用率为77%；排便功能障碍总体发生率为45%。在逻辑回归模型中，排便不完全形式的排便功能障碍仍与子宫托停用显著相关[比值比（OR）3.29，95%置信区间（CI）1.43 - 7.52]。无膨出症状（OR 2.18，95% CI 1.22 - 3.90）和较年轻年龄（OR 1.02，95% CI 1.02 - 1.05）也与子宫托停用显著相关。
子宫托停用很常见，排便不完全形式的排便功能障碍与停用的关联最强。了解子宫托停用的预测因素可能有助于指导临床医生和患者选择盆底功能障碍的治疗方案。
