Natale Franca, Illiano Ester, Zucchi Alessandro, Balzarro Matteo, La Penna Chiara, Costantini Elisabetta
Urogynecology Unit, San Carlo di Nancy Hospital, Via Ottorino Lazzarini, 5, 00136, Rome, Italy.
Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.
Int Urogynecol J. 2019 Sep;30(9):1519-1525. doi: 10.1007/s00192-019-03871-7. Epub 2019 Feb 4.
To assess whether detrusor underactivity (DU) is a risk factor for voiding dysfunction (VD) after transobturator tape (TOT) and if a detrusor pressure at maximum flow (PdetQmax) value predicts postoperative VD in DU patients. Also, we examined uncomplicated patients for postoperative VD.
This is a prospective long-term study on SUI patients who underwent TOT. Exclusion criteria were preoperative POP stage ≥ 2, previous anti-incontinence surgery and comorbidities. Patients were grouped by detrusor contractility using the projected isovolumetric pressure (PIP) index (PdetQmax + maximum flow rate) with values of 30-75 cmHO indicating normal contractility. Follow-up was at 1, 3, 6 and 12 months, and then annually. All patients underwent a stress test and responded to the Urogenital Distress Inventory questionnaire and to the King's Health Questionnaire. The subjective cure was evaluated using the Patient Global Impression of Improvement. We determined the diagnostic accuracy of PdetQmax levels using ROC curve analysis, with a cut-off point calculated for optimal sensitivity and specificity.
In 2007-2013, 118 patients underwent TOT. We included 50 in the undercontractility group (G1) and 50 in the normocontractility group (G2). Continence rates were 82% in G1 and 84% in G2 (mean follow-up 76 months). VD increased from 18 to 36% (p < 0.05) in G1 and from 14 to 16% (p = 0.198) in G2. De novo VD was 28% in G1 and 2% in G2. In the G1 group PdetQmax ≤ 12 cmHO predicted postoperative VD with 71.4% specificity and 80.0% sensitivity.
DU adversely affects the voiding phase of micturition after TOT. In DU patients, PdetQmax ≤ 12 cmHO predicts postoperative VD.
评估逼尿肌收缩功能减退（DU）是否为经闭孔尿道中段无张力吊带术（TOT）后排尿功能障碍（VD）的危险因素，以及最大尿流率时的逼尿肌压力（PdetQmax）值能否预测DU患者术后的VD。此外，我们还对未出现并发症的患者进行了术后VD检查。
这是一项对接受TOT的压力性尿失禁（SUI）患者进行的前瞻性长期研究。排除标准为术前盆腔器官脱垂（POP）分期≥2期、既往抗尿失禁手术史和合并症。根据预计等容压力（PIP）指数（PdetQmax + 最大尿流率）将患者按逼尿肌收缩力分组，该指数值在30 - 75 cmH₂O表明收缩力正常。随访时间为术后1、3、6和12个月，之后每年随访一次。所有患者均接受压力试验，并回答泌尿生殖系统困扰量表问卷和国王健康问卷。使用患者总体改善印象评估主观治愈率。我们采用ROC曲线分析确定PdetQmax水平的诊断准确性，并计算出最佳敏感性和特异性的截断点。
在2007 - 2013年期间，118例患者接受了TOT。我们将50例纳入收缩力减退组（G₁组），50例纳入收缩力正常组（G₂组）。G₁组的控尿率为82%，G₂组为84%（平均随访76个月）。G₁组的VD发生率从18%增至36%（p < 0.05），G₂组从14%增至16%（p = 0.198）。新发VD在G₁组为28%，在G₂组为2%。在G₁组中，PdetQmax≤12 cmH₂O预测术后VD的特异性为71.4%，敏感性为80.0%。
DU对TOT术后的排尿期有不利影响。在DU患者中，PdetQmax≤12 cmH₂O可预测术后VD。
