Harris R L, Cundiff G W, Coates K W, Bump R C
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Obstet Gynecol. 1998 Dec;92(6):951-4. doi: 10.1016/s0029-7844(98)00286-5.
To determine differences between vaginally parous and nulliparous women presenting with urinary incontinence and pelvic organ prolapse.
Seven hundred forty eight consecutive referrals with urinary incontinence or pelvic organ prolapse, 62 of whom were nulliparous, were included in the analysis. Five hundred thirty-seven (72%) had urinary incontinence and 235 (31%) had at least stage III pelvic organ prolapse. Each subject had standard history, physical examination, and multichannel urodynamic testing. Differences between parous and nulliparous women were compared using parametric and nonparametric analysis of variance and the chi2 test with Yates correction where appropriate.
The only significant demographic difference between the groups was that parous women had more previous continence and prolapse surgery. There were significant differences in distribution of diagnoses according to parity, with the nulliparas much less likely to have pelvic organ prolapse. Among incontinent women without prolapse, nulliparas were significantly more likely to have pure detrusor instability. Of those with pure genuine stress incontinence, nulliparas were older, had less anterior vaginal wall descent, less bladder neck mobility, narrower genital hiatus and perineal body measurements, and lower maximum urethral closure pressures. Of those with pure detrusor instability, the only difference was that nulliparas were significantly younger. For women with stage III pelvic organ prolapse or worse, no significant difference in any measured characteristic was noted.
Nulliparous women were less likely to present with pelvic organ prolapse and those with urinary incontinence differed little from incontinent parous women.
确定出现尿失禁和盆腔器官脱垂的经阴道分娩妇女与未生育妇女之间的差异。
对748例连续转诊的尿失禁或盆腔器官脱垂患者进行分析，其中62例为未生育妇女。537例（72%）有尿失禁，235例（31%）至少有Ⅲ期盆腔器官脱垂。每位受试者均接受了标准的病史采集、体格检查和多通道尿动力学检测。采用参数和非参数方差分析以及适当情况下采用Yates校正的卡方检验比较经产妇和未生育妇女之间的差异。
两组之间唯一显著的人口统计学差异是经产妇既往有更多的控尿和脱垂手术史。根据产次，诊断分布存在显著差异，未生育妇女发生盆腔器官脱垂的可能性要小得多。在没有脱垂的尿失禁妇女中，未生育妇女更有可能出现单纯逼尿肌不稳定。在单纯性真性压力性尿失禁患者中，未生育妇女年龄较大，阴道前壁脱垂较少，膀胱颈活动度较小，生殖裂孔和会阴体测量值较窄，最大尿道闭合压较低。在单纯逼尿肌不稳定的患者中，唯一的差异是未生育妇女明显更年轻。对于Ⅲ期或更严重盆腔器官脱垂的妇女，未观察到任何测量特征有显著差异。
未生育妇女发生盆腔器官脱垂的可能性较小，且尿失禁患者与经产妇尿失禁患者差异不大。
