Wu You Maria, Welk Blayne
Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada.
Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
Res Rep Urol. 2019 Jun 19;11:179-188. doi: 10.2147/RRU.S191555. eCollection 2019.
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Site-specific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.
压力性尿失禁（SUI）和盆腔器官脱垂（POP）在许多女性一生中都会出现。在本综述中，我们描述并评估SUI和POP的最新治疗选择，包括经阴道网片（TVM）使用方面的争议。越来越多的证据支持将盆底肌训练作为SUI和POP的一线治疗方法。阴道子宫托仍然是管理SUI和POP症状的一种有效且可逆的选择。中段尿道吊带仍然是SUI手术治疗的金标准，不过患者和临床医生应认识到TVM可能存在的严重并发症。Burch尿道固定术和耻骨阴道吊带术对SUI有良好的治愈率，对于希望避免植入网片的女性可能更受青睐；然而，它们的手术并发症以及更具挑战性的手术方式可能会限制其应用。对于孤立的阴道前壁或后壁脱垂，可考虑进行特定部位的膀胱膨出或直肠膨出修补术；然而，对于更严重的POP女性，有证据支持采用涉及顶端悬吊的阴道自体组织修复作为主要手术技术。虽然腹部和腹腔镜骶骨阴道固定术在治疗POP方面都有效，但它们的失败率和网片并发症发生率会随时间增加。由于缺乏长期数据，目前尚无足够证据支持广泛使用保留子宫的手术治疗POP。在POP手术中不建议常规使用TVM，仅应由训练有素的外科医生根据具体情况考虑，主要针对有多种POP复发风险因素的女性。一般来说，临床医生应根据女性的症状、合并症以及与网片相关并发症的风险因素，为其个体化制定SUI和POP的治疗方案。
