Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
J Formos Med Assoc. 2022 Dec;121(12):2424-2429. doi: 10.1016/j.jfma.2022.07.011. Epub 2022 Aug 18.
To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up.
Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation.
A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p < 0.01), as well as the pad weight (20.5 ± 2.7 vs. 9.4 ± 2.0, p < 0.001) and diagnosis of urodynamic stress incontinence (83% (132/160) vs. 51% (82/160), p < 0.01). Overactive bladder syndrome increased significantly after the operation (18% (29/160) vs. 28% (45/160), p = 0.03), even though the objective parameters, such as first and strong desire to void, bladder oversensitivity, and detrusor overactivity, were all improved after the operation. The pad weight was mostly improved significantly within the first postoperative 2 years. Eighteen (11%) women had global recurrent POP, and only one (0.6%) woman had true recurrence of cystocele. Twenty-four (15%) women had mesh extrusion, and two-thirds of them could be managed in an office setting.
In women with advanced cystocele, the ATVM surgery provides a favorable anatomic reduction outcome with an acceptable mesh extrusion rate. The ATVM provides an anti-incontinence effect, both in subjective symptoms and objective parameters, but this effect might decline after postoperative 2 years.
评估中期随访中经个体化改良经阴道前壁网片修补术（ATVM）治疗后的临床结局和尿动力学参数变化。
回顾性分析 2011 年 11 月至 2015 年 12 月期间因≥Ⅱ度盆腔器官脱垂（POP）行 ATVM 手术的患者。数据随访截止日期为 2021 年 12 月。在术前和术后评估患者的尿失禁和排尿症状的临床和尿动力学诊断。
共纳入 160 例患者。术后压力性尿失禁显著改善（99%（159/160）vs. 43%（68/160），p<0.01），同时也改善了尿垫重量（20.5±2.7 vs. 9.4±2.0，p<0.001）和尿动力学压力性尿失禁的诊断（83%（132/160）vs. 51%（82/160），p<0.01）。术后急迫性尿失禁显著增加（18%（29/160）vs. 28%（45/160），p=0.03），尽管术后客观参数如首次和强烈排尿意愿、膀胱过度敏感和逼尿肌过度活动均有所改善。术后 2 年内，尿垫重量大多显著改善。18 例（11%）患者发生整体复发性 POP，仅有 1 例（0.6%）患者发生真正的膀胱膨出复发。24 例（15%）患者发生网片突出，其中三分之二可在门诊进行处理。
对于晚期膀胱膨出患者，ATVM 手术可提供良好的解剖复位效果，网片突出率可接受。ATVM 提供抗尿失禁效果，包括主观症状和客观参数，但这种效果可能在术后 2 年后下降。
