From the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology.
Center for Clinical and Translational Science.
Female Pelvic Med Reconstr Surg. 2021 Aug 1;27(8):e608-e613. doi: 10.1097/SPV.0000000000000996.
The aim of this study was to compare failure rates of first voiding trial (VT) within 7 days and on postoperative day (POD) 1 after colpocleisis with versus without concomitant midurethral sling (MUS). Predictors of POD 1 VT failure were also examined.
This was a retrospective cohort study of women undergoing colpocleisis from January 2012 to October 2019 comparing VT outcomes with versus without MUS. Primary outcome was first VT failure within 7 days; outcomes of VTs performed on POD 1 were also assessed. Association between MUS and VT failure and predictors of POD 1 VT failure were assessed via logistic regression.
Of 119 women, 45.4% had concomitant MUS. First VT was performed on mean POD 3.1 ± 2.2 in the MUS group versus POD 1.8 ± 1.8 in the no MUS group (P < 0.01). The MUS group was less likely to undergo POD 1 VT (50% vs 83%, P < 0.01). Failure of the first VT did not differ (22.2% with MUS vs 32.8% without MUS, P = 0.20); no association between VT failure and MUS was noted (adjusted odds ratio [aOR], 0.6; 95% confidence interval [CI], 0.18-2.1). There were 68.1% (81/119) of participants who underwent POD 1 VT, MUS was performed in 33.3% (27/81). The POD 1 failure did not differ between those with 33.3% versus 40.7% without MUS (P = 0.52). Midurethral sling was not associated with POD 1 VT failure (aOR, 0.93; 95% CI, 0.27-3.23). In women undergoing POD 1 VT, preoperative postvoid residual was associated with VT failure (aOR, 1.39; 95% CI, 1.01-1.92).
In women undergoing colpocleisis, MUS was not associated with VT failure within 7 days or on POD 1. Increased preoperative postvoid residual was associated with POD 1 VT failure.
本研究旨在比较经阴道闭孔尿道中段悬吊术（MUS）与不经阴道闭孔尿道中段悬吊术治疗阴道前后壁修补术后第 1 天（POD1）和第 7 天首次排尿试验（VT）失败率。同时还探讨了 POD1 时 VT 失败的预测因素。
这是一项回顾性队列研究，纳入了 2012 年 1 月至 2019 年 10 月期间接受阴道前后壁修补术的患者，比较了有和无 MUS 的 VT 结果。主要结局是 7 天内首次 VT 失败；还评估了 POD1 时进行的 VT 结果。通过逻辑回归评估 MUS 与 VT 失败的关系，以及 POD1 VT 失败的预测因素。
在 119 名患者中，45.4%同时行 MUS。MUS 组首次 VT 于术后第 3.1 ± 2.2 天进行，无 MUS 组于术后第 1.8 ± 1.8 天进行（P<0.01）。MUS 组更不可能进行 POD1 VT（50%比 83%，P<0.01）。首次 VT 失败率无差异（MUS 组 22.2%，无 MUS 组 32.8%，P=0.20）；未发现 VT 失败与 MUS 之间存在关联（调整后的优势比[aOR]，0.6；95%置信区间[CI]，0.18-2.1）。119 名参与者中有 68.1%（81/119）接受了 POD1 VT，其中 33.3%（27/81）进行了 MUS。有 MUS 组与无 MUS 组的 POD1 失败率无差异（P=0.52）。在接受 POD1 VT 的患者中，MUS 组占 33.3%，无 MUS 组占 40.7%。
在接受阴道前后壁修补术的患者中，MUS 与第 7 天或 POD1 时的 VT 失败无关。术前残余尿量与 POD1 VT 失败相关。
