Department of Obstetrics and Gynecology, Aalborg University Hospital, Denmark.
Department of Obstetrics and Gynecology, Aalborg University Hospital, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:142-146. doi: 10.1016/j.ejogrb.2021.05.018. Epub 2021 May 13.
As the population ages, obliterative procedures (OP) are expected to become an increasingly important treatment option. The primary aim of this study was to evaluate vaginal and urinary symptoms 3 months after OP and peri- and postoperative complications. The secondary aim was to investigate long-term outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA.
Retrospective study of 43 women who underwent OP during a 10-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 3 months postoperatively and at long-term follow-up. Records were reviewed for complications, use of anesthetics, recurrences, patient satisfaction and regret.
A Le Fort colpocleisis was performed in 31 (72 %) and a colpectomy in 12 (28 %) patients. At 3 months` follow-up, patients had a statistically significant improvement in vaginal symptoms. Twelve patients (46 %) became continent, compared with 14 (54 %) with remaining urinary incontinence (UI). There were no patients with de novo UI 3 months' after surgery. Total complication rate was 4,6% (2/43). A symptomatic recurrent prolapse occurred in 4 patients (9.3 %). The satisfaction rate was 86 %. No patients reported regret choosing to have vaginal closure surgery. Twenty one (49 %) of the procedures were performed under local anesthesia with intravenous sedation.
Obliterative procedures are good surgical options for elderly women with a positive impact on vaginal and urinary symptoms, low complication and recurrence rate. Patients report high satisfaction and no regret over loss of sexual ability at longterm follow-up. OP under LA with intravenous sedation is a feasible and safe option.
随着人口老龄化，闭塞性手术（OP）预计将成为一种越来越重要的治疗选择。本研究的主要目的是评估 OP 术后 3 个月的阴道和尿失禁症状以及围手术期并发症。次要目的是调查长期结果，包括患者满意度、后悔率和 OP 后症状性复发脱垂的发生率。另一个次要目的是评估在局部麻醉（LA）下进行 OP 的可行性，因为越来越多的手术在 LA 下进行。
回顾性研究了 43 名在 10 年内接受 OP 的女性患者。患者在手术前、术后 3 个月和长期随访时完成了国际尿失禁咨询问卷-阴道症状（ICIQ-VS）和国际尿失禁咨询问卷-尿失禁简短问卷（ICIQ-UI SF）中的三个脱垂问题。记录并发症、麻醉剂使用、复发、患者满意度和后悔情况。
31 名（72%）患者行阴道勒福科尔阴道成形术，12 名（28%）患者行阴道切除术。在 3 个月的随访中，患者的阴道症状有显著改善。12 名（46%）患者成为尿失禁患者，14 名（54%）患者仍有尿失禁。术后 3 个月无新发尿失禁患者。总并发症发生率为 4.6%（2/43）。4 名患者（9.3%）出现症状性复发脱垂。满意度为 86%。没有患者后悔选择阴道封闭手术。21 例（49%）手术在局部麻醉加静脉镇静下进行。
闭塞性手术是老年女性的一种良好手术选择，对阴道和尿失禁症状有积极影响，并发症和复发率低。患者在长期随访中报告高满意度，对丧失性功能无后悔。LA 加静脉镇静下的 OP 是一种可行且安全的选择。
