UPMC Magee-Womens Hospital, and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Department of Obstetrics and Gynecology, Trinity Health Of New England, Hartford, Connecticut.
Obstet Gynecol. 2019 Oct;134(4):736-744. doi: 10.1097/AOG.0000000000003448.
To evaluate the proportion of women who experienced resolution of stress urinary incontinence (SUI) symptoms after surgery for pelvic organ prolapse (POP) without a concomitant incontinence procedure.
We conducted a retrospective observational study of women with preoperative subjective and objective SUI who underwent minimally invasive sacrocolpopexy or uterosacral ligament suspension from 2009 to 2015. We excluded cases with incontinence procedures. The primary outcome was the proportion of women with subjective resolution of SUI postoperatively, defined as the absence of patient reported SUI symptoms during follow-up. Secondary outcomes included the proportion of women who underwent a subsequent staged midurethral sling (MUS) procedure and factors associated with resolution of SUI and staged MUS placement.
Of 93 women, most were white (n=90, 98%) with stage III POP (n=55, 59%). Mean age was 59.5±8.9 years and body mass index 28.7±4.7. Seventy-three patients (78%) underwent minimally invasive sacrocolpopexy, and 20 (22%) underwent uterosacral ligament suspension. Median follow-up was 8.3 months (interquartile range 3.4-26.7). Postoperatively, 28 (30%) patients reported resolution of SUI, and 65 (70%) reported persistent SUI. Of the 93 patients, 47 (51%) were treated for persistent SUI and 34 (37%) underwent a staged MUS procedure. Among the staged MUS procedures, 27 (79%) were placed within 12 months. Median time to staged MUS procedure was 5.5 months (interquartile range 4.2-9.9). After controlling for degree of preoperative SUI bother, obese women were less likely to experience resolution of SUI after prolapse repair (odds ratio 0.28, 95% CI 0.08-0.95). We did not identify any factors that were significantly associated with undergoing a staged MUS procedure on univariate analyses (P>.05).
Preoperative SUI resolved in nearly a third of women after prolapse surgery without a concomitant incontinence procedure. In a population typically offered a concomitant MUS procedure at the time of prolapse repair, a staged approach may result in nearly two-thirds fewer patients undergoing MUS procedures. This information may be helpful during preoperative shared decision making.
评估因盆腔器官脱垂（POP）而接受微创骶骨阴道固定术或子宫骶骨固定术（无同时进行的控尿手术）的女性患者术后压力性尿失禁（SUI）症状缓解的比例。
我们对 2009 年至 2015 年期间因术前有主观和客观 SUI 而接受微创骶骨阴道固定术或子宫骶骨固定术的女性进行了回顾性观察性研究。我们排除了有控尿手术的病例。主要结局是术后有主观 SUI 缓解的女性比例，定义为随访期间无患者报告的 SUI 症状。次要结局包括接受后续分期中尿道吊带（MUS）手术的女性比例，以及与 SUI 缓解和分期 MUS 放置相关的因素。
93 名女性中，大多数为白人（n=90，98%），POP 分期为 III 期（n=55，59%）。平均年龄为 59.5±8.9 岁，体重指数为 28.7±4.7。73 例（78%）患者接受了微创骶骨阴道固定术，20 例（22%）患者接受了子宫骶骨固定术。中位随访时间为 8.3 个月（四分位距 3.4-26.7）。术后，28 名（30%）患者报告 SUI 缓解，65 名（70%）患者报告 SUI 持续存在。93 名患者中，47 名（51%）因持续 SUI 接受治疗，34 名（37%）接受了分期 MUS 手术。分期 MUS 手术中，27 例（79%）在 12 个月内完成。分期 MUS 手术的中位时间为 5.5 个月（四分位距 4.2-9.9）。在校正术前 SUI 困扰程度后，肥胖女性在脱垂修复后 SUI 缓解的可能性较小（比值比 0.28，95%CI 0.08-0.95）。在单变量分析中，我们没有发现任何与分期 MUS 手术显著相关的因素（P＞0.05）。
在没有同时进行控尿手术的情况下，近三分之一的女性在脱垂手术后 SUI 得到缓解。在通常在脱垂修复时同时提供分期 MUS 手术的人群中，分期方法可能使近三分之二的患者无需接受 MUS 手术。这些信息在术前共同决策时可能会有所帮助。
