Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; University of Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; University of Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Metro Health - University of Michigan Health, Grand Rapids, MI.
Am J Obstet Gynecol. 2021 Jul;225(1):70.e1-70.e12. doi: 10.1016/j.ajog.2021.02.020. Epub 2021 Feb 20.
Müllerian agenesis, or Mayer-Rokitansky-Küster-Hauser syndrome, occurs in 1 in 4500 to 5000 individuals assigned female sex at birth. Pelvic floor symptoms among individuals with Mayer-Rokitansky-Küster-Hauser syndrome have not been well studied, and it is unknown how vaginal lengthening treatments affect these symptoms.
This study aimed to assess urinary, prolapse, and bowel symptoms in individuals with Mayer-Rokitansky-Küster-Hauser syndrome and to determine whether symptoms vary by vaginal lengthening treatment.
We conducted a cross-sectional study in 2019 using an online survey distributed by the Beautiful You MRKH Foundation via social media to individuals with Mayer-Rokitansky-Küster-Hauser syndrome. Demographics, age at and timing of diagnosis, information about vaginal lengthening treatment, urinary symptoms (Michigan Incontinence Symptom Index), prolapse symptoms (Pelvic Organ Prolapse Distress Inventory short-form version), and bowel symptoms (Bristol Stool Form Scale) were obtained. The inclusion criteria included self-reported diagnosis of müllerian agenesis and female sex. Respondents with a history of renal transplant or dialysis, completion of <85% of the survey, and non-English survey responses were excluded. Descriptive analyses were used to describe the sample population. Logistic regression, Kruskal-Wallis, and Fisher exact tests were used to compare the prevalence of pelvic floor symptoms and vaginal lengthening treatments. Associations between age and genitourinary symptoms were investigated with Spearman correlations.
Of 808 respondents, 615 met the inclusion criteria, representing 40 countries. 81% of respondents identified as white. The median age of the participants was 29 years (interquartile range, 24-36), with a median age at diagnosis of 16 years (interquartile range, 15-17). Among the 614 respondents, 331 (54%) had vaginal lengthening treatment, 130 of whom (39%) had undergone surgical vaginal lengthening. Of individuals with Mayer-Rokitansky-Küster-Hauser syndrome, 428 of 614 (70%) reported having had one or more urinary symptoms, and 339 of 428 (79%) reported being bothered by these symptoms. Urinary symptoms included urinary incontinence (210 of 614 [34%]), urinary frequency (245 of 614 [40%]), urinary urgency (248 of 614 [40%]), pain with urination (97 of 614 [16%]), and recurrent urinary tract infections (177 of 614 [29%]). Prolapse symptoms included lower abdominal pressure (248 of 612 [41%]), pelvic heaviness or dullness (177 of 610 [29%]), and vaginal bulge (68 of 609 [11%]). In addition, constipation was reported by 153 of 611 respondents (25%), and anal incontinence was reported by 153 of 608 (25%) respondents. Beside recent urinary incontinence (P=.003) and anal incontinence (P<.001), the prevalence of pelvic floor symptoms (P>.05) did not differ significantly between those with and without vaginal lengthening. Among those with surgical vaginal lengthening, symptomatic vaginal bulge was highest in individuals who underwent a bowel vaginoplasty procedure.
Urinary, prolapse, and bowel symptoms are common among individuals with Mayer-Rokitansky-Küster-Hauser syndrome and should be evaluated in this population. Overall, compared with no vaginal lengthening treatment, having vaginal lengthening treatment is not associated with substantial differences in the prevalence of pelvic floor symptoms, with the exception of recent urinary incontinence and anal incontinence. Our data suggested that bowel vaginoplasty may be associated with greater symptoms of vaginal bulge. More robust studies are needed to determine the impact of various vaginal lengthening treatments on pelvic floor symptoms.
Müllerian 发育不全,又称 Mayer-Rokitansky-Küster-Hauser 综合征,在出生时被分配为女性的个体中每 4500 至 5000 例中就有 1 例发生。Mayer-Rokitansky-Küster-Hauser 综合征患者的盆底症状尚未得到很好的研究,也不知道阴道延长治疗如何影响这些症状。
本研究旨在评估 Mayer-Rokitansky-Küster-Hauser 综合征患者的尿失禁、脱垂和肠症状,并确定症状是否因阴道延长治疗而有所不同。
我们于 2019 年进行了一项横断面研究,通过 Beautiful You MRKH 基金会通过社交媒体向 Mayer-Rokitansky-Küster-Hauser 综合征患者在线调查。获取人口统计学资料、诊断年龄和时间、阴道延长治疗信息、尿失禁症状(密歇根尿失禁症状指数)、脱垂症状(盆腔器官脱垂困扰量表简表)和肠症状(布里斯托粪便量表)。纳入标准包括自我报告的 müllerian 发育不全诊断和女性性别。排除有肾移植或透析病史、完成调查的比例<85%和非英语调查回复的受访者。使用描述性分析描述样本人群。使用逻辑回归、Kruskal-Wallis 和 Fisher 精确检验比较盆底症状和阴道延长治疗的患病率。使用 Spearman 相关性分析调查年龄与泌尿生殖系统症状之间的关系。
在 808 名受访者中,615 名符合纳入标准,代表 40 个国家。81%的受访者为白人。参与者的中位年龄为 29 岁(四分位距,24-36),中位诊断年龄为 16 岁(四分位距,15-17)。在 614 名受访者中,331 名(54%)接受了阴道延长治疗,其中 130 名(39%)接受了手术阴道延长。在 Mayer-Rokitansky-Küster-Hauser 综合征患者中,614 名中有 428 名(70%)报告有 1 种或多种尿失禁症状,其中 339 名(79%)报告这些症状困扰他们。尿失禁症状包括尿失禁(614 名中的 210 名[34%])、尿频(614 名中的 245 名[40%])、尿急(614 名中的 248 名[40%])、尿痛(614 名中的 97 名[16%])和复发性尿路感染(614 名中的 177 名[29%])。脱垂症状包括下腹部压力(612 名中的 248 名[41%])、盆腔沉重或钝痛(610 名中的 177 名[29%])和阴道膨出(609 名中的 68 名[11%])。此外,611 名受访者中有 153 名(25%)报告便秘,608 名受访者中有 153 名(25%)报告肛门失禁。除了最近的尿失禁(P=.003)和肛门失禁(P<.001)外,阴道延长治疗与无症状之间的盆腔症状患病率(P>.05)无显著差异。在接受手术阴道延长的患者中,进行肠阴道成形术的患者中阴道膨出的症状最为严重。
Mayer-Rokitansky-Küster-Hauser 综合征患者常有尿失禁、脱垂和肠症状,应在该人群中进行评估。总体而言,与没有阴道延长治疗相比,阴道延长治疗与盆底症状的患病率没有显著差异,除了最近的尿失禁和肛门失禁。我们的数据表明,肠阴道成形术可能与更大的阴道膨出症状有关。需要更有力的研究来确定各种阴道延长治疗对盆底症状的影响。