Chang Heng-Wei, Ng Soo-Cheen, Chen Gin-Den
Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
Department of Obstetrics and Gynecology, Chung Shan Medical University, Taichung, Taiwan.
Low Urin Tract Symptoms. 2021 Apr;13(2):238-243. doi: 10.1111/luts.12357. Epub 2020 Nov 22.
Previous studies have shown that anterior vaginal wall prolapse (AVWP) results in reduction of pressure in the proximal urethra. However, the effect of severity of AVWP on urethral pressure is controversial. This study aimed to evaluate parameters of the urethral pressure profile in different stages of AVWP.
From 2016 to 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were enrolled in this study to analyze their urethral pressure profiles. Stages of AVWP were regrouped into three groups ranging from mild to severe stages (groups 1-3). Maximal urethral pressure, urethral closure pressure, functional urethral length, length of continence zone, as well as area of continence zone were compared among these three groups.
Distribution of age, parity, and menopausal women were significantly different among these three groups. Maximal urethral pressure (pressures for groups 1, 2, and 3 were 74.6∼75.9cmH2O, 69.7∼73.4cmH2O, and 58.3∼60.5cmH2O, respectively; all P<.05) and stress urethral closure pressure (pressures for groups 1, 2, and 3 were 69.3cmH2O, 62.3cmH2O, and 52.2cmH2O, respectively; all P<.05) gradually and significantly decreased, consistent with the severity of AVWP. However, the attenuated maximal urethral pressure and stress urethral closure pressure in accordance with severity did not show any significant difference after controlling for age, body mass index, parity, menopause, and stress urinary incontinence symptoms.
Our results showed that AVWP significantly attenuated urethral pressure. However, patient age, menopausal status, and number of parities seem to be more influential in compromising urethral function than just AVWP alone.
既往研究表明，阴道前壁脱垂（AVWP）会导致尿道近端压力降低。然而，AVWP严重程度对尿道压力的影响存在争议。本研究旨在评估不同阶段AVWP患者的尿道压力分布参数。
2016年至2017年，本研究纳入了286例因泌尿妇科问题转诊至我院尿动力学检查室的患者，分析其尿道压力分布情况。AVWP的阶段被重新划分为从轻度到重度的三组（第1 - 3组）。比较这三组患者的最大尿道压力、尿道闭合压力、功能性尿道长度、控尿区长度以及控尿区面积。
这三组患者的年龄、产次和绝经女性分布存在显著差异。最大尿道压力（第1、2、3组的压力分别为74.6∼75.9cmH₂O、69.7∼73.4cmH₂O和58.3∼60.5cmH₂O；所有P <.05）和压力性尿道闭合压力（第1、2、3组的压力分别为69.3cmH₂O、62.3cmH₂O和52.2cmH₂O；所有P <.05）随着AVWP严重程度逐渐显著降低。然而，在控制年龄、体重指数、产次、绝经状态和压力性尿失禁症状后，根据严重程度降低的最大尿道压力和压力性尿道闭合压力未显示出任何显著差异。
我们的结果表明，AVWP显著降低了尿道压力。然而，患者年龄、绝经状态和产次似乎比单纯的AVWP对尿道功能损害的影响更大。
