Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Jyväskylä, Finland.
Pelvic Floor Unit, Monash Health, Melbourne, Australia.
Aust N Z J Obstet Gynaecol. 2021 Apr;61(2):263-269. doi: 10.1111/ajo.13290. Epub 2020 Dec 25.
Causes for occult stress urinary incontinence (SUI) are poorly recognised.
To explore the mechanisms behind occult SUI. We hypothesised that cystocele type affects the risk of occult SUI.
We conducted a retrospective, cross-sectional study on 878 consecutive women assessed at a tertiary urogynaecologic clinic between July 2016 and November 2018. The population of this study consisted of 424 women with urodynamic stress incontinence. Women with previous anti-incontinence surgery were excluded. All women underwent a standardised interview, clinical examination and urodynamic testing. Translabial ultrasound was used to categorise cystoceles into Green type II (cystocele with open retrovesical angle) and Green type III (cystocele with intact retrovesical angle). We compared women with overt SUI to those with occult SUI (defined as stress incontinence only observed after prolapse reduction) for demographic characteristics, urodynamic findings and functional anatomy. Predictors for occult SUI were identified with a multivariable logistic regression model.
Of 424 women, 362 (85%) had overt, and 62 (15%) occult SUI. There were 136 (32%) women who had a significant cystocele on imaging; 57 (42%) were classified as type II and 79 (58%) as type III. On multivariable regression, age and cystocele type were significantly associated with occult SUI. Odds for occult SUI was 10.9 times higher with type III (cystocele with an intact retrovesical angle) than with type II cystocele (cystocele with an open retrovesical angle; 95% CI 1.3-90.9).
Cystocele type affects the risk of occult SUI. Type III cystocele (intact retrovesical angle) associates with occult SUI.
隐匿性压力性尿失禁（SUI）的病因认识不足。
探讨隐匿性 SUI 的发病机制。我们假设膀胱膨出的类型会影响隐匿性 SUI 的风险。
我们对 2016 年 7 月至 2018 年 11 月在一家三级泌尿科妇科诊所接受评估的 878 例连续女性患者进行了回顾性、横断面研究。本研究人群包括 424 例尿动力学压力性尿失禁患者。排除了既往抗失禁手术的女性。所有女性均接受了标准化的访谈、临床检查和尿动力学检查。经阴道超声将膀胱膨出分为 Green Ⅱ型（膀胱膨出伴开放的膀胱后角）和 Green Ⅲ型（膀胱膨出伴完整的膀胱后角）。我们比较了有显性 SUI 的女性和隐匿性 SUI 的女性（仅在脱垂复位后观察到压力性尿失禁）的人口统计学特征、尿动力学发现和功能解剖结构。使用多变量逻辑回归模型确定隐匿性 SUI 的预测因素。
在 424 例女性中，362 例（85%）为显性，62 例（15%）为隐匿性 SUI。有 136 例（32%）女性影像学检查有明显的膀胱膨出；57 例（42%）为Ⅱ型，79 例（58%）为Ⅲ型。多变量回归分析显示，年龄和膀胱膨出类型与隐匿性 SUI 显著相关。与Ⅱ型膀胱膨出（膀胱后角开放）相比，Ⅲ型（膀胱后角完整）膀胱膨出发生隐匿性 SUI 的几率高 10.9 倍（95%CI：1.3-90.9）。
膀胱膨出的类型影响隐匿性 SUI 的风险。Ⅲ型膀胱膨出（完整的膀胱后角）与隐匿性 SUI 相关。
