Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON.
Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON.
J Obstet Gynaecol Can. 2020 Apr;42(4):420-429. doi: 10.1016/j.jogc.2017.10.037. Epub 2019 Dec 18.
Pelvic organ prolapse (POP) surgery may unmask occult stress urinary incontinence (OSUI) in otherwise asymptomatic patients. Preoperative urodynamic studies (UDSs) with prolapse reduction may, by potentially unmasking OSUI, assist surgical decision making. This study investigated the long-term objective postoperative rate of SUI, according to the presence of OSUI.
This retrospective cohort study was conducted with a cross-sectional survey of women with no SUI or rare SUI presenting at Kingston General Hospital in Kingston, Ontario from 2003-2013 for POP. Patients were compared on the basis of preoperative UDS results and whether an anti-incontinence procedure was performed in addition to POP surgery. The study included a chart review of 1-year follow-up subjective results and a survey of long-term objective results (symptoms and quality of life) ascertained by validated questionnaires.
The study enrolled 113 women, 51 of whom had undergone anti-incontinence surgery (42 for identified OSUI, 9 prophylactically). In women whose UDS results indicated OSUI, 1-year subjective and long-term objective postoperative SUI results were, respectively, 8.8% and 12.5% among women undergoing POP and anti-incontinence surgery and 18.2% and 42.9% among those undergoing POP surgery alone. In women with negative UDS results, those rates were 0.0% and 50.0% and 12.8% and 27.6%, respectively. There was no significant difference in any outcomes, according to procedure choice in the OSUI-positive group. There were no predictors for postoperative SUI.
Although a trend was seen for less long-term validated subjective SUI in women having a concomitant SUI procedure along with POP corrective surgery, no significant difference in outcomes was found, on the basis of procedure of choice, and no reliable predictors for postoperative SUI could be identified. UDS testing may be useful to rule in OSUI, but its clinical value in surgical decision making is uncertain.
盆腔器官脱垂（POP）手术可能会使原本无症状的患者出现隐匿性压力性尿失禁（OSUI）。通过降低脱垂进行术前尿动力学研究（UDS），可能会通过揭示 OSUI 来辅助手术决策。本研究根据是否存在 OSUI ，调查了长期术后尿失禁的客观发生率。
本回顾性队列研究对 2003 年至 2013 年期间在安大略省金斯顿金斯敦总医院就诊的无压力性尿失禁或罕见压力性尿失禁的 POP 女性进行了横断面调查。根据术前 UDS 结果以及 POP 手术之外是否进行了抗失禁手术，对患者进行了比较。该研究包括对 1 年随访的主观结果进行图表回顾，并通过经过验证的问卷对长期的客观结果（症状和生活质量）进行调查。
该研究共纳入 113 名女性，其中 51 名接受了抗失禁手术（42 例因 OSUI ，9 例预防性）。在 UDS 结果提示 OSUI 的女性中，POP 和抗失禁手术组的 1 年主观和长期客观术后尿失禁发生率分别为 8.8%和 12.5%，而仅接受 POP 手术的女性分别为 18.2%和 42.9%。UDS 结果阴性的女性，这些发生率分别为 0.0%和 50.0%以及 12.8%和 27.6%。在 OSUI 阳性组中，根据手术选择，各结果之间没有显著差异。术后尿失禁无预测因素。
尽管在同时进行 POP 矫正手术和 SUI 手术的女性中，长期经过验证的主观尿失禁发生率较低，但根据手术选择，结果没有显著差异，也无法确定术后尿失禁的可靠预测因素。UDS 测试可能有助于明确 OSUI，但在手术决策中的临床价值尚不确定。
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