有症状的盆腔器官脱垂患者行腹腔镜骶骨阴道固定术后的尿动力学检查结果及功能转归
Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse.
作者信息
Illiano Ester, Natale Franca, Giannantoni Antonella, Gubbiotti Marilena, Balzarro Matteo, Costantini Elisabetta
机构信息
Andrology and Urogynecological Clinic, Santa Maria Hospital Terni, University of Perugia, Piazzale Tristano di Joanuccio, Terni, Italy.
Urogynecology Unit, San Carlo di Nancy Hospital, Rome, Italy.
出版信息
Int Urogynecol J. 2019 Apr;30(4):589-594. doi: 10.1007/s00192-019-03874-4. Epub 2019 Feb 2.
INTRODUCTION AND HYPOTHESIS
The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP).
METHODS
In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery.
RESULTS
Median follow- up was 22 months (range 8-48). After surgery, maximum flow (Q) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001).
CONCLUSIONS
The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.
引言与假设
本研究旨在评估II-IV期盆腔器官脱垂（POP）患者行腹腔镜骶骨阴道固定术（LSC）后的功能结局及尿动力学检查结果。
方法
在这项单中心前瞻性研究中，我们评估了63例有症状的晚期POP（II-IV期）女性（平均年龄62.5±7.5岁），她们接受了LSC且未同时进行抗尿失禁手术。术前评估包括病史、临床检查和尿动力学检查。术后1、3、6和12个月对患者进行随访，之后每年通过病史、检查和尿流率测定进行随访。在术后6个月，我们进行了尿动力学检查。为评估泌尿系统症状，我们在手术前和术后6个月使用了泌尿生殖系统困扰量表（UDI）-6问卷。
结果
中位随访时间为22个月（范围8-48个月）。术后，最大尿流率（Q）与基线相比显著改善（14.17±2.3 vs 27±8.4 ml/s；p=0.02），残余尿量（PVR）升高的患者百分比显著降低（33.3% vs 11.1%；p=0.001）。分别有73.6%和85.7%的患者逼尿肌过度活动和膀胱出口梗阻消失，而66.6%的女性仍存在逼尿肌活动不足。20例女性（31.7%）术前报告有压力性尿失禁（SUI）（14例临床明显，6例为隐匿型），LSC术后仅7/20（11%）患者仍存在，无新发病例。最常见的术前症状为排尿症状，42/63（66.6%）患者存在，其中36例（85.7%）症状缓解。60%的女性膀胱过度活动症消失，无新发病例。UDI-6评分从基线时的中位数16（0-45）显著降至最终随访时的5.5（0-17）（p=0.001），这反映了上述结果。UDI-6的储尿期症状（中位数3 vs 1）和排尿期症状（中位数3 vs 1）领域在术后有所改善（p=0.001）。
结论
尿动力学检查结果表明，晚期POP女性行LSC可获得良好的功能结局。
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