Byck D B, Varner R E, Clough C
Department of Obstetrics and Gynecology, University of Alabama at Birmingham.
Am J Obstet Gynecol. 1994 Dec;171(6):1460-2; discussion 1462-4. doi: 10.1016/0002-9378(94)90388-3.
Postoperative bladder complaints after incontinence procedures are well known to the pelvic surgeon, but there are few reports comparing subjective complaints with objective data. Thirty of 68 patients who underwent a modified Burch urethral suspension were interviewed and examined by the first author. Four-channel urodynamics were then performed.
Of the 30 patients, eight (27%) complained of postoperative urinary leaking, and three of eight (10%) said they leaked worse than before surgery. Four patients (13%) had objective evidence of detrusor instability on cystometrogram. Two patients (6%) had recurrent genuine stress incontinence. No patients had bladder spams or symptoms of retention. Univariate and multivariate analyses were performed on the following preoperative patient factors in relation to surgical success: age, height, hormonal status, and concurrent pelvic relaxation. Only preoperative hormone use had statistical significance in relation to surgical success.
The eight patients with leaking were treated on the basis of subjective complaints plus objective findings. The patients with detrusor instability had improvement with medication and bladder drills, but two of the four still had mild leakage. Of the other four patients, one required a urethral sling and is now dry. The other three patients had significant improvement or cure of symptoms after modifications were made in their voiding techniques.
Our study suggests that preoperative and postoperative estrogen use is significantly correlated with surgical success of the Burch procedure, whereas age, weight, and postoperative pelvic relaxation have little influence. We also found that surgical success could be improved by close evaluation and individual management of patients with voiding complaints.
盆腔外科医生都熟知尿失禁手术后的膀胱相关问题，但将主观症状与客观数据进行对比的报道却很少。第一作者对68例接受改良Burch尿道悬吊术的患者中的30例进行了访谈和检查，随后进行了四通道尿动力学检查。
在这30例患者中，8例（27%）主诉术后有尿液渗漏，其中3例（10%）表示渗漏情况比手术前更严重。4例（13%）患者在膀胱测压图上有逼尿肌不稳定的客观证据。2例（6%）患者出现复发性真性压力性尿失禁。没有患者出现膀胱痉挛或尿潴留症状。对以下术前患者因素与手术成功率的关系进行了单因素和多因素分析：年龄、身高、激素状态和并发的盆腔松弛情况。只有术前激素使用情况与手术成功率具有统计学意义。
对8例有渗漏的患者根据主观症状和客观检查结果进行了治疗。逼尿肌不稳定的患者通过药物治疗和膀胱训练有改善，但4例中的2例仍有轻度渗漏。在其他4例患者中，1例需要使用尿道吊带，现在已无渗漏。另外3例患者在排尿技巧调整后症状有显著改善或治愈。
我们的研究表明，术前和术后使用雌激素与Burch手术的成功率显著相关，而年龄、体重和术后盆腔松弛影响较小。我们还发现，通过对有排尿问题的患者进行密切评估和个体化管理，可以提高手术成功率。
