盆腔器官脱垂腹腔镜侧方悬吊术后膀胱过度活动症的评估
Assessment of Overactive Bladder after Laparoscopic Lateral Suspension for Pelvic Organ Prolapse.
作者信息
Malanowska Ewelina, Starczewski Andrzej, Bielewicz Włodzimierz, Balzarro Matteo
机构信息
Department of Gynaecology, Endocrinology and Gynaecologic Oncology of Pomeranian Medical University, Szczecin 70-001, Poland.
Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, 37121 Verona, Italy.
出版信息
Biomed Res Int. 2019 Apr 4;2019:9051963. doi: 10.1155/2019/9051963. eCollection 2019.
BACKGROUND
Pelvic organ prolapses (POP) and overactive bladder (OAB) may coexist and both negatively impact quality of life in women. The correlation between POP and OAB remains unclear, but these patients may have the OAB resolution after the surgical treatment of POP. Aim of our study was to assess the anatomical results and the effect on OAB symptoms in women who underwent laparoscopic lateral suspension for POP.
MATERIALS AND METHODS
This prospective study included all women with apical POP who underwent surgical repair with laparoscopic uterine lateral suspension from January 2016 to December 2017. The baseline and the 1-year follow-up included post-void residual measurement, urinalysis, vaginal examination, OAB symptoms evaluation, and administration of questionnaires (PFDI-20, UDI 6).
RESULTS
64 women underwent laparoscopic lateral suspension for uterine prolapse and 78.1% had concomitant anterior vaginal wall defect. At 1-year follow-up the anatomic success rates were 84.4% for the apical and 76.2% for the anterior compartment. The comparison between OAB symptoms before and after the surgical procedure showed the resolution of OAB in 76% of the women, while de novo OAB was present in 2.6%. With the questionnaires 95.3% (61/64) of our patients were satisfied after the POP repair. We documented a trend in ameliorating of OAB regardless of the POP-Q stage. However, the Pearson test showed this correlation as statistically significant only in women with anterior vaginal wall defect stage III and apical stage II. No patient had vaginal exposure of the polypropylene mesh.
CONCLUSION
Our data show how laparoscopic lateral suspension is an effective procedure for apical and anterior vaginal wall defects. This study provides further evidence for the concept that OAB in women with POP >II stage improves after a successful POP surgery. These women may benefit from a resolution of OAB and POP symptoms with the improvement of patient's quality of life.
背景
盆腔器官脱垂（POP）和膀胱过度活动症（OAB）可能并存，二者均会对女性的生活质量产生负面影响。POP与OAB之间的相关性尚不清楚，但这些患者在接受POP手术治疗后可能会使OAB症状得到缓解。本研究的目的是评估接受腹腔镜下侧方悬吊术治疗POP的女性的解剖学结果以及对OAB症状的影响。
材料与方法
这项前瞻性研究纳入了2016年1月至2017年12月期间接受腹腔镜子宫侧方悬吊术进行手术修复的所有顶端POP女性患者。基线检查和1年随访包括测定排尿后残余尿量、尿液分析、阴道检查、OAB症状评估以及问卷调查（PFDI-20、UDI 6）。
结果
64名女性接受了腹腔镜下子宫脱垂侧方悬吊术，78.1%伴有阴道前壁缺损。在1年随访时，顶端解剖学成功率为84.4%，前盆腔为76.2%。手术前后OAB症状的比较显示，76%的女性OAB症状得到缓解，而新发OAB的比例为2.6%。通过问卷调查，95.3%（61/64）的患者在POP修复术后感到满意。我们记录到无论POP-Q分期如何，OAB均有改善趋势。然而，Pearson检验显示，这种相关性仅在阴道前壁缺损III期和顶端II期的女性中具有统计学意义。没有患者出现聚丙烯网片的阴道外露情况。
结论
我们的数据表明，腹腔镜下侧方悬吊术是治疗顶端和阴道前壁缺损的有效方法。本研究为以下概念提供了进一步的证据：POP>II期女性患者在成功进行POP手术后，OAB症状会得到改善。这些女性可能会从OAB和POP症状的缓解以及生活质量的改善中获益。
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