Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, 2160 S First Avenue, Maywood, IL, 60153, USA.
Biostatistics Core, Public Health Sciences, Center for Translational Research and Education, Loyola University Chicago, Maywood, USA.
Int Urogynecol J. 2021 Mar;32(3):729-736. doi: 10.1007/s00192-021-04705-1. Epub 2021 Feb 6.
The optimal method of managing stress urinary incontinence (SUI) in women undergoing colpocleisis remains unclear, especially in a setting of urinary retention. We aim to compare postoperative retention after colpocleisis with or without concomitant midurethral sling (MUS).
A retrospective chart review of all women who underwent colpocleisis with or without MUS from October 2007 to October 2017 was performed. Women with preoperative and 2-week postoperative post-void residual volume (PVR) measurements were included. Urinary retention was defined as PVR of ≥100 ml. Analysis included t tests/Wilcoxon rank, Chi-squared/Fisher's exact, and multivariate linear regression models.
A total of 231 women with a mean age of 77.7 years (± 6.0 years SD) met the inclusion criteria. One hundred and thirty-eight women underwent colpocleisis alone, whereas 93 women had colpocleisis with MUS. Preoperative retention rates were high (44.9% vs 34.4%, for colpocleisis alone versus with MUS, p = 0.114). Postoperative retention rates were lower and similar between the groups (10.1% vs 11.8%, for colpocleisis alone vs with MUS, p = 0.69). Linear regression models showed the adjusted odds ratio for postoperative urinary retention in patients with concomitant MUS was 1.68 (95% confidence interval: 0.64-4.41) compared with patients with colpocleisis alone and this did not reach statistical significance (p = 0.292). Fortunately, after colpocleisis, women had high rates of resolution of retention, regardless of MUS (80.3% vs 90.6% for colpocleisis alone vs with MUS; p = 0.20). Few women required reoperation for retention (3.1%).
Placement of an MUS at the time of colpocleisis is a safe and effective therapy. This appears to be unaffected by preoperative urinary retention status.
对于行经阴道闭孔尿道中段悬吊术（MUS）的女性，管理压力性尿失禁（SUI）的最佳方法仍不清楚，尤其是在存在尿潴留的情况下。我们旨在比较经阴道闭孔尿道中段悬吊术（MUS）联合与不联合经阴道闭孔尿道中段悬吊术（MUS）治疗后的术后尿潴留。
对 2007 年 10 月至 2017 年 10 月期间行经阴道闭孔尿道中段悬吊术（MUS）联合与不联合经阴道闭孔尿道中段悬吊术（MUS）的所有女性进行了回顾性图表审查。纳入术前和术后 2 周时的剩余尿量（PVR）测量的女性。尿潴留定义为 PVR 大于等于 100ml。分析包括 t 检验/Wilcoxon 秩和检验、卡方/Fisher 确切检验和多元线性回归模型。
共有 231 名平均年龄 77.7 岁（±6.0 岁标准差）的女性符合纳入标准。138 名女性仅行经阴道闭孔尿道中段悬吊术（MUS），93 名女性行经阴道闭孔尿道中段悬吊术（MUS）联合经阴道闭孔尿道中段悬吊术（MUS）。术前尿潴留率较高（单独行经阴道闭孔尿道中段悬吊术（MUS）的为 44.9%，联合行经阴道闭孔尿道中段悬吊术（MUS）的为 34.4%，p=0.114）。术后两组的尿潴留率较低且相似（单独行经阴道闭孔尿道中段悬吊术（MUS）的为 10.1%，联合行经阴道闭孔尿道中段悬吊术（MUS）的为 11.8%，p=0.69）。线性回归模型显示，与单独行经阴道闭孔尿道中段悬吊术（MUS）的患者相比，同时行经阴道闭孔尿道中段悬吊术（MUS）的患者术后发生尿潴留的调整优势比为 1.68（95%置信区间：0.64-4.41），但无统计学意义（p=0.292）。幸运的是，无论是否同时行经阴道闭孔尿道中段悬吊术（MUS），行经阴道闭孔尿道中段悬吊术（MUS）后女性的潴留缓解率均较高（单独行经阴道闭孔尿道中段悬吊术（MUS）的为 80.3%，联合行经阴道闭孔尿道中段悬吊术（MUS）的为 90.6%；p=0.20）。很少有女性需要再次手术治疗（3.1%）。
在经阴道闭孔尿道中段悬吊术（MUS）时放置 MUS 是一种安全有效的治疗方法。这似乎不受术前尿潴留状态的影响。
