Cruz Rodrigo A, Faria Carlos A, Gomes Saint-Clair S
Department of Gynecology, Fernandes Figueira Institute - FIOCRUZ, 22250-020, Rio de Janeiro, Brazil.
Maternal and Child Department, Faculty of Medicine, Fluminense Federal University, 24220-000, Niterói, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:15-20. doi: 10.1016/j.ejogrb.2020.07.033. Epub 2020 Jul 22.
The aims of this study are to describe the postoperative incidence of de novo stress urinary incontinence (SUI) in women who underwent anterior vaginal compartment prolapse repair using synthetic polypropylene mesh and to identify risk factors for this outcome.
A retrospective cohort study of 146 women who underwent anterior vaginal repair from 2007 to 2017 and followed by a minimum period of 12 months was performed. The incidence of de novo SUI was evaluated at 3 and 12 months of follow-up. Women with concomitant or prior anti-incontinence surgery were not included. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on urodynamics. The outcome was considered positive if the patient had complaints of SUI at the follow-up. Variables associated with the outcome with a p-value ≤ 0.10 were included in a logistic regression model to calculate the relative risk (RR) for de novo SUI. For multivariate analysis, all analyzes were performed considering a significant p-value ≤ 0.05.
The incidence of de novo SUI at 3 and 12 months of follow-up was 15.8 % and 20.5 %, respectively. Higher body mass index (BMI), diabetes, anterior vaginal wall prolapse stage ≥ 3, older age at first pregnancy and higher first desire to void during the urodynamic evaluation were positively associated with de novo SUI in the bivariate analysis (p ≤ 0.10). Previous perineoplasty had a negative association with the outcome analyzed, suggesting a protective effect. After the multivariate analysis, higher BMI (RR 1.19, 95 % confidence interval [CI] 1.05-1.36), diabetes (RR 4.18, 95 % CI 1.32-13.21) and anterior vaginal wall prolapse stage ≥ 3 (RR 14.74, 95 % CI 1.64-132.0) remained as risk factors for de novo SUI (p ≤ 0.01).
The incidence of de novo SUI after the surgical correction of anterior vaginal wall prolapse with synthetic mesh in this population was 15.8 % and 20.5 % at 3 and 12 months of follow-up, respectively. Continent women who underwent this surgical procedure and who had a higher BMI, diabetes and anterior vaginal wall prolapse stage ≥ 3 had a higher risk of presenting de novo SUI.
本研究旨在描述使用合成聚丙烯网片进行阴道前壁修补术的女性术后新发压力性尿失禁（SUI）的发生率，并确定该结果的危险因素。
对2007年至2017年接受阴道前壁修补术且随访至少12个月的146名女性进行回顾性队列研究。在随访3个月和12个月时评估新发SUI的发生率。不包括同时进行或既往接受过抗尿失禁手术的女性。术前，所有患者压力试验均为阴性，尿动力学检查未发现隐匿性SUI的证据。如果患者在随访时有SUI主诉，则结果被视为阳性。将p值≤0.10的与结果相关的变量纳入逻辑回归模型，以计算新发SUI的相对风险（RR）。对于多变量分析，所有分析均在显著p值≤0.05的情况下进行。
随访3个月和12个月时，新发SUI的发生率分别为15.8%和20.5%。在双变量分析中，较高的体重指数（BMI）、糖尿病、阴道前壁脱垂≥3期、首次妊娠年龄较大以及尿动力学评估时较高的首次排尿意愿与新发SUI呈正相关（p≤0.10）。既往会阴成形术与所分析的结果呈负相关，提示有保护作用。多变量分析后，较高的BMI（RR 1.19，95%置信区间[CI] 1.05 - 1.36）、糖尿病（RR 4.18，95% CI 1.32 - 13.21）和阴道前壁脱垂≥3期（RR 14.74，95% CI 1.64 - 132.0）仍然是新发SUI的危险因素（p≤0.01）。
在该人群中，使用合成网片手术矫正阴道前壁脱垂后，随访3个月和12个月时新发SUI的发生率分别为15.8%和20.5%。接受该手术且BMI较高、患有糖尿病以及阴道前壁脱垂≥3期的非尿失禁女性出现新发SUI的风险更高。
