Department of Urology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Urology, Algemeen Ziekenhuis West, Veurne, Belgium.
J Urol. 2020 Mar;203(3):598-603. doi: 10.1097/JU.0000000000000575. Epub 2019 Oct 4.
Women with pelvic organ prolapse are at risk for stress urinary incontinence after prolapse surgery. Combining pelvic organ prolapse repair with anti-incontinence surgery reduces the incontinence rate but leads to overtreatment. Performing only pelvic organ prolapse repair leads to under treatment. Is a vaginal ring pessary a useful tool when deciding whether a mid urethral sling should be added to prolapse surgery?
We performed a retrospective cohort study in women with symptomatic pelvic organ prolapse but without bothersome stress urinary incontinence who underwent vaginal prolapse repair between January 1, 2008 and December 31, 2017. Preoperatively a pessary was inserted in all women to detect occult stress urinary incontinence. If the pessary revealed bothersome stress urinary incontinence, a concomitant mid urethral sling was proposed. The primary outcome at followup was de novo stress urinary incontinence.
Included in study were 220 women. After pessary insertion 132 women (60%) remained continent, 20 (9%) reported nonbothersome stress urinary incontinence and 68 (31%) had bothersome stress urinary incontinence. The latter group was offered combined surgery. At followup bothersome stress urinary incontinence was present in 12 of the 132 women (9%) who had been continent preoperatively and in 7 of the 20 (35%) who had had nonbothersome stress urinary incontinence. In 132 women who were continent with the pessary a total of 11 mid urethral sling procedures would have been needed to prevent postoperative stress urinary incontinence in 1 (number needed to treat was 11). In the 20 women who had nonbothersome stress urinary incontinence only 3 mid urethral sling procedures would have been necessary (number needed to treat was 3).
In women with symptomatic pelvic organ prolapse a pessary is a useful tool when deciding whether to add a mid urethral sling.
患有盆腔器官脱垂的女性在脱垂手术后有发生压力性尿失禁的风险。将盆腔器官脱垂修复与抗失禁手术相结合可降低尿失禁率，但会导致过度治疗。仅行盆腔器官脱垂修复会导致治疗不足。阴道环型子宫托在决定是否在脱垂手术中添加中尿道吊带时是否是一种有用的工具？
我们对 2008 年 1 月 1 日至 2017 年 12 月 31 日期间接受阴道脱垂修复的患有症状性盆腔器官脱垂但无明显压力性尿失禁的女性进行了回顾性队列研究。所有女性在术前均插入子宫托以检测隐匿性压力性尿失禁。如果子宫托显示有明显的压力性尿失禁，则建议同时行中尿道吊带术。随访时的主要结局为新发压力性尿失禁。
研究共纳入 220 例女性。子宫托插入后，132 例女性（60%）仍保持无尿失禁，20 例（9%）报告无明显压力性尿失禁，68 例（31%）有明显压力性尿失禁。后者组被建议行联合手术。随访时，132 例术前无尿失禁的女性中有 12 例（9%）出现明显压力性尿失禁，20 例（35%）有非明显压力性尿失禁的女性中有 7 例（35%）出现明显压力性尿失禁。在 132 例子宫托无尿失禁的女性中，需要 11 例（需要治疗人数为 11）中尿道吊带术才能预防术后压力性尿失禁；在 20 例非明显压力性尿失禁的女性中，仅需要 3 例（需要治疗人数为 3）中尿道吊带术。
在有症状性盆腔器官脱垂的女性中，子宫托是决定是否添加中尿道吊带时的一种有用工具。
