Women's University Hospital of Jena, Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of University of Jena, Eisenach, Germany.
Sci Rep. 2021 Nov 10;11(1):22011. doi: 10.1038/s41598-021-01565-z.
Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann-Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67-8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03-1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85-2.38) and defect type (p = 0.02, B - 1.42, 95% CI - 2.65 to - 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.
在接受前壁原位组织修复的脱垂患者中，我们回顾性评估了尿道长度。使用曼-惠特尼和威尔科克森检验以及线性和逻辑回归分析了年龄、脱垂分期、缺陷模式、尿动力学和临床压力测试结果以及无张力阴道吊带（TVT）手术指征对尿道长度的影响。在 394 名患者中，61%患有 II/III 期脱垂，39%患有 IV 期脱垂；90%的缺陷为中央型（10%为侧方型）。术前和术后尿道长度中位数分别为 14 和 22mm（p<0.01）。侧方缺陷的术前尿道长度较大（p<0.01，B6.38，95%置信区间[CI]为 4.67-8.08），并且增加了压力性尿失禁的风险（p<0.01，比值比[OR]为 1.07，95%CI 为 1.03-1.12）。术后尿道长度取决于脱垂分期（p<0.01，B1.61，95%CI 为 0.85-2.38）和缺陷类型（p=0.02，B-1.42，95%CI 为-2.65 至-0.2）。术后，5.1%（中位数为 9 个月）的患者需要接受 TVT 手术，这些患者的尿道长度比没有接受该手术的患者长（p=0.043）。包括 Kelly 折叠术在内的前壁原位组织修复增加了尿道长度，这反映了尿道再成形，尤其是中央型缺陷。应进一步研究结缔组织老化背景下尿道长度的功能影响。
