Beverly C M, Walters M D, Weber A M, Piedmonte M R, Ballard L A
Cleveland Clinic Foundation, Department of Obstetrics and Gynecology, OH 44195, USA.
Obstet Gynecol. 1997 Jul;90(1):37-41. doi: 10.1016/S0029-7844(97)00240-8.
To determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse.
The charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990, and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery.
Of 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 +/- 10.2 years (range 35-93) and median parity was 3.0 (range 0-10). Of the 323 patients, 25 (7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis, and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. Two patients with hydronephrosis had evidence of renal insufficiency (creatinine > or = 1.6), and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower in patients with vaginal vault prolapse versus uterine prolapse (3.9% compared with 12.6%, P < .01),
The prevalence of hydronephrosis in patients undergoing surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse, and is lower in patients with vaginal vault prolapse that in those with uterine prolapse.
确定盆腔器官脱垂手术患者肾积水的患病率，并确定肾积水是否与脱垂的类型和严重程度相关。
回顾了1990年1月1日至1993年12月31日在克利夫兰诊所基金会连续接受盆腔器官脱垂手术的375例患者的病历。根据放射科医生确定的最终诊断，对术前肾脏超声和静脉肾盂造影（IVP）进行肾积水评估。脱垂的严重程度根据术前门诊检查或手术时的麻醉下检查确定。
375例患者中，323例进行了术前肾脏超声或IVP检查。平均年龄为66.0±10.2岁（范围35 - 93岁），中位产次为3.0（范围0 - 10）。在323例患者中，25例（7.7%，95%置信区间5，11）有肾积水。13例患者（4.0%）有轻度肾积水，9例（2.8%）有中度肾积水，3例（0.9%）有重度肾积水。肾积水的患病率随着脱垂严重程度的增加而增加。两名肾积水患者有肾功能不全的证据（肌酐≥1.6），且均有严重双侧肾积水和完全性子宫脱垂。阴道穹窿脱垂患者的肾积水患病率低于子宫脱垂患者（3.9%比12.6%，P <.01）。
主要因盆腔器官脱垂接受手术的患者中肾积水的患病率较低，随着盆腔器官脱垂加重而增加，且阴道穹窿脱垂患者的患病率低于子宫脱垂患者。
