因固有括约肌缺陷导致压力性尿失禁的女性，行可调式中段尿道吊带术后新发膀胱过度活动症的预测因素。
Predictors for De Novo Overactive Bladder after Readjustable Mid-Urethral Sling Procedure in Women with Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency.
机构信息
Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Department of Urology, CHA Seoul Station Fertility Center, CHA University, Seoul, Republic of Korea.
出版信息
Biomed Res Int. 2018 Nov 26;2018:6934747. doi: 10.1155/2018/6934747. eCollection 2018.
PURPOSE
This study identified noninvasive factors that predict overactive bladder (OAB) after readjustable mid-urethral sling surgery (Remeex system) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 130 women with SUI due to ISD [Valsalva leak-point pressure (VLPP) <60 cm HO] who underwent the Remeex procedure between February 2011 and March 2017. Patients were classified according to OAB symptoms before and 6 months after the Remeex procedure: Group 1, without preoperative and postoperative OAB (=46); Group 2, without preoperative OAB and with postoperative OAB (de novo OAB, =15); Group 3, with preoperative OAB and without postoperative OAB (=25); Group 4, with preoperative and postoperative OAB (=44). Noninvasive clinical and urodynamic factors were evaluated as predictors of de novo OAB.
RESULTS
The four groups significantly differed with respect to age (=0.036), peak urinary flow rate (PUFR) one month after surgery (post-PUFR, =0.001), and postvoid residual (PVR) one month after surgery (post-PVR, =0.005). No significant differences were detected for body mass index, diabetes, multiparity, menopause, previous hysterectomy, previous incontinence surgery, previous pelvic organ prolapse surgery, pyuria, preoperative PUFR, preoperative PVR, maximal cystometric capacity, VLPP, maximum urethral closure pressure, detrusor pressure at PUFR, and detrusor overactivity (>0.05). Post-PUFR decreased significantly compared with preoperative PUFR in Groups 1, 2, and 4 (=0.002, =0.001, and =0.001, respectively). Pairwise comparisons of post-PUFR and post-PVR revealed statistically significant differences between Group 2 and other groups (<0.0125). Multivariate logistic regression analyses showed that post-PUFR was the only significant predictor of de novo OAB (odds ratio = 0.823, 95% confidence interval 0.727-0.931, =0.002).
CONCLUSIONS
Reduced PUFR after the Remeex procedure is a promising predictor of risk for de novo OAB. This metric is noninvasive and easy to measure.
目的
本研究旨在确定女性压力性尿失禁（SUI）合并内源性括约肌缺陷（ISD）行可调节尿道中段吊带术（Remeex 系统）后发生膀胱过度活动症（OAB）的非侵入性预测因素。
材料和方法
我们回顾性分析了 2011 年 2 月至 2017 年 3 月间 130 例因 ISD 行 Remeex 手术的 SUI 患者（Valsalva 漏点压（VLPP）<60cmH2O）的病历。根据 Remeex 术前和术后 6 个月的 OAB 症状将患者分为 4 组：无术前和术后 OAB（组 1，46 例）；无术前 OAB 但术后出现 OAB（新发 OAB，组 2，15 例）；术前有 OAB 但术后无 OAB（组 3，25 例）；术前和术后均有 OAB（组 4，44 例）。评估非侵入性临床和尿动力学因素是否为新发 OAB 的预测因素。
结果
4 组在年龄（=0.036）、术后 1 个月最大尿流率（post-PUFR，=0.001）和术后 1 个月残余尿量（post-PVR，=0.005）方面差异有统计学意义。组间体重指数、糖尿病、多胎妊娠、绝经、子宫切除术、既往尿失禁手术、既往盆腔器官脱垂手术、脓尿、术前最大尿流率、术前残余尿量、最大膀胱容量、VLPP、最大尿道闭合压、尿流率时逼尿肌压、逼尿肌过度活动无明显差异（>0.05）。与术前最大尿流率相比，组 1、2 和 4 的 post-PUFR 均显著下降（=0.002，=0.001，=0.001）。两两比较发现，组 2 与其他组间 post-PUFR 和 post-PVR 差异有统计学意义（<0.0125）。多变量逻辑回归分析显示，post-PUFR 是新发 OAB 的唯一显著预测因素（优势比=0.823，95%置信区间 0.727-0.931，=0.002）。
结论
Remeex 术后最大尿流率降低是新发 OAB 的一个有前途的预测因素。该指标是非侵入性的，易于测量。
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