Chavez Jacqueline A, Fuentes Jorge L, Christie Alana L, Alhalabi Feras, Carmel Maude E, Lemack Gary E, Zimmern Philippe E
Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110.
Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, TX 75390-8852.
Urology. 2021 Aug;154:103-108. doi: 10.1016/j.urology.2021.03.034. Epub 2021 Apr 11.
To review the rates of persistent and de novo stress urinary incontinence (SUI) following urethral diverticulum (UD) repairs performed without concomitant SUI surgical procedures.
Following IRB approval, charts of women who underwent UD excision by three FPMRS surgeons were reviewed. Data collected from the electronic medical record included demographic information, preoperative symptoms and evaluation (validated questionnaires [UDI-6, QoL]), imaging studies, operative details, post-operative symptoms, and subsequent surgical interventions. Excluded were women with <6 months follow-up or concomitant pubovaginal sling placement. SUI was diagnosed by patient report, and UD was confirmed by preoperative magnetic resonance imaging or voiding cystourethrogram. The primary outcome was defined as the rate of SUI following UD repair. Secondary outcomes included resolution of pre-operative SUI, rate of self-reported secondary SUI, and SUI surgical intervention post-UD repair.
From 2003-2018, 61 of 67 women met study criteria. SUI pre-UD repair was reported in 31 of 61 (51%). During UD repair, 3 patients underwent Martius flap interposition. Post-UD repair, 18/61 (30%) reported SUI. Persistent SUI was present in 14 of 31 (45%), and de novo SUI occurred in 4 of 30 (13%). Postoperative responses revealed statistically significant improvements in QoL and most questions of UDI-6 at median 18 months. SUI was surgically managed in 3 patients using bulking agent injections (2) and autologous fascial sling placement (1). Overall, 3 of 61 (5%) underwent SUI intervention post-UD repair.
Without prophylactic SUI corrective procedures performed during UD repair, we observed a low rate of de novo SUI, and only 5% with bothersome SUI opting for surgical intervention.
回顾在未同时进行压力性尿失禁（SUI）手术的情况下，尿道憩室（UD）修复术后持续性和新发SUI的发生率。
经机构审查委员会（IRB）批准，对三位女性盆底医学与重建外科（FPMRS）医生进行UD切除术的女性患者病历进行回顾。从电子病历中收集的数据包括人口统计学信息、术前症状及评估（经过验证的问卷[UDI-6、生活质量量表]）、影像学检查、手术细节、术后症状以及后续手术干预情况。排除随访时间不足6个月或同时进行耻骨后阴道吊带置入术的女性患者。SUI通过患者报告进行诊断，UD通过术前磁共振成像或排尿性膀胱尿道造影确诊。主要结局定义为UD修复术后SUI的发生率。次要结局包括术前SUI的缓解情况、自我报告的继发性SUI发生率以及UD修复术后SUI的手术干预情况。
2003年至2018年，67名女性中有61名符合研究标准。61名患者中有31名（51%）报告术前存在SUI。在UD修复术中，3例患者进行了Martius皮瓣插入术。UD修复术后，61名患者中有18名（30%）报告存在SUI。31名术前存在SUI的患者中有14名（45%）仍存在持续性SUI，30名术前无SUI的患者中有4名（13%）出现新发SUI。术后反应显示，在中位18个月时，生活质量量表和UDI-6的大多数问题在统计学上有显著改善。3例患者通过注射填充剂（2例）和自体筋膜吊带置入术（1例）对SUI进行了手术治疗。总体而言，61名患者中有3名（5%）在UD修复术后接受了SUI干预。
在UD修复术中未进行预防性SUI矫正手术的情况下，我们观察到新发SUI的发生率较低，只有5%的烦扰性SUI患者选择手术干预。
