Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R
Department of Obstetrics and Gynecology, Third Branch of the University of Milan, San Gerardo Hospital, Monza, Italy.
Am J Obstet Gynecol. 1997 Feb;176(2):337-43. doi: 10.1016/s0002-9378(97)70495-2.
Our purpose was to compare two antiincontinence procedures in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence.
In addition to cystopexy, 109 patients with a urethrocystocele of grade 2 or more and a positive stress test result with prolapse reduction received posterior pubourethral ligament plication or Pereyra suspension.
Of 55 patients undergoing posterior pubourethral ligament plication, 15 were clinically and 40 potentially incontinent; the same figures were 21 and 33, respectively, among 54 patients undergoing the Pereyra procedure. Follow-up was for 3 to 9 years. Subjective (60% vs 71%, p = 0.72) and objective (27% vs 57%, p = 0.14) cure rates were not statistically different among patients who were clinically incontinent (posterior pubourethral ligament plication vs Pereyra suspension). Among potentially incontinent patients, subjective (85% vs 100%, p = 0.03) and objective (50% vs 76%, p = 0.04) continence rates were higher after the Pereyra procedure. Overall, the cotton swab test had negative results (maximum straining angle < or = 30 degrees) after successful surgery in 79% and 96%, respectively, of patients (p = 0.03). Four subjects (7%) underwent removal of one Pereyra suture because of urinary retention or suprapubic wound infection.
Cystopexy with Pereyra suspension is recommended, particularly for patients with prolapse and potential stress incontinence.
我们的目的是比较两种抗尿失禁手术在患有严重泌尿生殖系统脱垂并伴有临床或潜在压力性尿失禁患者中的效果。
除膀胱固定术外，109例2级或以上尿道膀胱膨出且脱垂复位后压力试验结果为阳性的患者接受了耻骨后尿道韧带折叠术或佩雷拉悬吊术。
在接受耻骨后尿道韧带折叠术的55例患者中，15例为临床尿失禁，40例为潜在尿失禁；在接受佩雷拉手术的54例患者中，相应数字分别为21例和33例。随访时间为3至9年。临床尿失禁患者（耻骨后尿道韧带折叠术与佩雷拉悬吊术）的主观治愈率（60%对71%，p = 0.72）和客观治愈率（27%对57%，p = 0.14）无统计学差异。在潜在尿失禁患者中，佩雷拉手术后的主观（85%对100%，p = 0.03）和客观（50%对76%，p = 0.04）控尿率更高。总体而言，成功手术后，棉签试验结果为阴性（最大用力角度≤30度）的患者分别占79%和96%（p = 0.03）。4名患者（7%）因尿潴留或耻骨上伤口感染而取出了一根佩雷拉缝线。
建议行膀胱固定术加佩雷拉悬吊术，特别是对于脱垂并伴有潜在压力性尿失禁的患者。
