Colombo M, Maggioni A, Zanetta G, Vignali M, Milani R
Department of Obstetrics and Gynecology, University of Milan, San Gerardo Hospital, Monza, Italy.
Obstet Gynecol. 1996 Feb;87(2):266-71. doi: 10.1016/0029-7844(95)00378-9.
To compare cystopexy alone versus cystopexy with posterior pubourethral ligaments plication for the occurrence of postoperative stress incontinence after prolapse surgery, and to compare the two surgical series in terms of complications and urodynamic effects.
One hundred two continent patients randomly underwent cystopexy alone (N = 52) or cystopexy with posterior pubourethral ligaments plication (N = 50). All had a urethrocystocele grade 2 or greater and a negative stress test with the prolapse repositioned. A full urodynamic investigation was repeated 6 months after surgery.
Twelve (23%) and 14 (28%) patients (P = .73) required intermittent self-catheterization for 11.1 +/- 5.1 and 16.5 +/- 11.1 days, respectively (cystopexy alone versus cystopexy with posterior pubourethral ligaments plication, P = .002). Long-lasting difficulties in voiding were present in zero and five (10%) patients (P = .02). One subject receiving posterior pubourethral ligaments plication underwent urethral dilation for complete urinary retention. At 1 year follow-up, four patients (8%) in each series developed postoperative stress incontinence (P = .62). Symptomatic detrusor instability complicated the postoperative course in one patient (2%) of each group.
Cystopexy alone implied lower morbidity in terms of resumption of spontaneous voiding and long-lasting difficulties in voiding. The procedure could be recommended as an effective and safe treatment for continent patients with severe urethrocystocele. Additional plication of the posterior pubourethral ligaments did not seem superior to cystopexy alone in preventing the postoperative occurrence of stress incontinence.
比较单纯膀胱固定术与膀胱固定术联合耻骨后尿道韧带折叠术在脱垂手术后压力性尿失禁的发生率，并比较两组手术在并发症和尿动力学效应方面的情况。
102例控尿患者被随机分为单纯膀胱固定术组（N = 52）或膀胱固定术联合耻骨后尿道韧带折叠术组（N = 50）。所有患者均有2级或以上尿道膀胱膨出且脱垂复位后压力试验阴性。术后6个月重复进行全面的尿动力学检查。
分别有12例（23%）和14例（28%）患者（P = 0.73）需要间歇性自我导尿，时间分别为11.1±5.1天和16.5±11.1天（单纯膀胱固定术组与膀胱固定术联合耻骨后尿道韧带折叠术组，P = 0.002）。排尿长期困难的患者在单纯膀胱固定术组为0例，在联合手术组为5例（10%）（P = 0.02）。1例接受耻骨后尿道韧带折叠术的患者因完全性尿潴留接受了尿道扩张术。在1年随访时，每组各有4例患者（8%）出现术后压力性尿失禁（P = 0.62）。两组各有1例患者（2%）出现症状性逼尿肌不稳定，使术后病程复杂化。
就恢复自主排尿和排尿长期困难而言，单纯膀胱固定术的发病率较低。该手术可作为重度尿道膀胱膨出控尿患者的一种有效且安全的治疗方法推荐。在预防术后压力性尿失禁方面，额外的耻骨后尿道韧带折叠术似乎并不优于单纯膀胱固定术。
