经阴道子宫全切手术对尿失禁症状的影响

目的:研究经阴道子宫全切手术患者手术前后尿失禁发生的情况和相关因素分析。方法:通过国际尿失禁咨询委员会(Intemational Consultant on Incontinence,ICI)提供的短表问卷，电话了解103例患者术前及术后半年后尿失禁的症状和程度。调集病历，了解其一般情况，妇科疾病的类型和手术方式等，分析尿失禁发生的影响因素。结果:①术前有尿失禁的44例(42.7％)，有尿失禁症状组的顺产次数、子宫脱垂及绝经人数均较无症状组差异有显著性；②有尿失禁症状的患者，其症状的发生与体重指数及年龄的增加相关；③手术后较手术前压力性及混合性尿失禁发生的比率有显著性下降，而急迫性尿失禁术前后无显著性改变。结论:体重指数和年龄的增加是发生尿失禁的高危因素。且分娩次数、是否绝经及是否有子宫脱垂也和尿失禁的发生有关。经阴道子宫全切手术可降低术后压力性和混合性尿失禁发生的比率。     

全子宫切除术后穹隆疝的手术处理及临床分析

目的探讨因子宫脱垂或其他因素行全子宫切除术后发生穹隆疝的处理方式。方法对2011年1月至2015年12月就诊于中国医科大学附属盛京医院行全子宫切除术后发生盆腔器官脱垂107例及其中的80例穹隆疝患者的手术处理方式进行回顾性分析。结果 107例患者中,单纯膀胱膨出或直肠膨出27例;以穹隆膨出为主,伴或不伴有膀胱和直肠膨出80例。80例患者中,子宫脱垂行全子宫切除32例,其他原因行全子宫切除48例;重度压力性尿失禁14例,尿动力学提示隐匿性尿失禁3例;行经阴道置入网片的盆底重建术76例,其中全盆底重建术56例,中盆腔重建术20例;2例腹腔镜下阴道骶骨固定术,1例单纯疝囊修补术,1例前盆底重建术+疝囊修补术。17例压力性尿失禁患者中,16例术中同时行TVT-O术。随访至2016年12月,平均随访时间38个月,无复发病例,3例患者出现网片暴露,1例隐匿性尿失禁患者于术后1年因尿失禁症状较重,行TVT-O手术。结论置入网片的盆底重建术是治疗子宫切除术后阴道穹隆疝的一种有效的手术方式,术前根据穹隆疝及合并阴道前后壁脱垂的程度选择恰当的手术重建方式。对于术前合并压力性尿失禁或隐匿性尿失禁患者术中应同时行TVT-O手术。     

盆腔器官脱垂应用网片术后疗效观察

目的:评价盆腔器官脱垂应用网片术后的疗效。方法:回顾分析2007年4月～2009年4月收住入院的盆腔器官脱垂病例24例(包括2例子宫切除术后穹窿脱垂,4例合并压力性尿失禁),应用网片盆底重建,评价术后各项客观和主观疗效。以POP-Q评分为客观疗效评价指标,以盆底功能障碍问卷(PFDI-20)为主观评价指标。结果:手术均顺利完成,术后恢复良好,无1例血管损伤、尿道损伤膀胱及直肠损伤。术后随访,无感染,无复发,无性生活障碍,补片侵蚀发生率8.33%,经治疗后好转,子宫脱垂复发2例。尿失禁、肛门坠胀感各1例,经治疗后症状消失。结论:网片用于盆腔器官脱垂的治疗安全,有效,术后并发症少,值得推广,仍需长期随访。     

全子宫切除术对子宫肌瘤患者下尿路症状影响的前瞻性研究

目的通过子宫肌瘤患者全子宫切除术前、术后下尿路症状的变化情况,探讨全子宫切除术对子宫肌瘤患者下尿路症状影响。方法收集2012年6月至2015年6月北京大学人民医院因子宫异常出血或月经量改变行全子宫切除术后病理结果证实为子宫平滑肌瘤患者169例。参考Bristol女性下尿路症状及对生活质量影响的调查问卷,调查患者术前及术后3个月下尿路症状情况。结果 (1)169例子宫肌瘤患者中,术前贮尿期症状的患病率为53.8%(91/169),术后贮尿期症状的患病率为57.4%(97/169);手术前后尿频、尿急、夜尿增多、压力性和急迫性尿失禁等症状的患病率比较,差异均无统计学意义(P0.05);(2)169例子宫肌瘤患者术前排尿症状的患病率为16.0%(27/169),术后为57.4%(97/169);(3)169例子宫肌瘤患者术前尿频(32.0%,54/169)、尿急(10.7%,18/169)、夜尿增多症状(21.9%,37/169),术后3个月超过50%改善或消失,术前压力性尿失禁症状(33.3%,35/105)在术后(25.7%,9/35)改善或消失;(4)169例子宫肌瘤患者术前贮尿期症状阳性的患者子宫体积(168.38±83.59)cm3大于无贮尿期症状患者(120.98±76.61)cm3(P=0.027)。结论全子宫切除术对子宫肌瘤患者下尿路症状的患病率无明显影响。术前存在的尿频、尿急、夜尿增多症状术后改善明显。子宫体积可能为子宫肌瘤患者贮尿期症状的影响因素。     

73例腹腔镜子宫/阴道骶骨固定术治疗盆腔器官脱垂的疗效观察

目的:探讨腹腔镜子宫/阴道骶骨固定术对盆腔器官脱垂(POP)患者的临床疗效。方法:分析2012年11月至2017年8月我院经POP定量分度法(POP-Q)证实为阴道穹窿脱垂Ⅱ期以上、中盆腔缺陷为主的POP初治患者(≥Ⅲ期)以及部分POP手术后复发患者73例,分别行腹腔镜子宫/阴道骶骨固定术。手术前后分别依据POP-Q、国际尿失禁调查问卷(ICIQ-SF)、盆底功能障碍疾病相关问卷-简要版(PFDI-20)、盆底疾病生活影响问卷-简易版7(PFIQ-7)、盆底器官脱垂/尿失禁对性功能影响的调查问卷(PISQ-12)、尿失禁生活质量影响问卷(I-QOL)、泌尿生殖道疾病相关问卷-6(UDI-6)、尿失禁影响程度相关问卷-7(IIQ-7)分别评价解剖和功能疗效。结果:73例患者均成功完成手术,4例行腹腔镜下子宫骶骨固定术,5例行经阴道全子宫切除术+腹腔镜下骶骨固定术,64例行腹腔镜下全子宫切除术+骶骨固定术。POP-Q分期Aa、Ba、C、Ap、Bp各指示点解剖位置均数由术前(2.12±1.27)cm、(3.66±2.92)cm、(2.65±2.68)cm、(0.79±1.91)cm、(1.56±3.04)cm分别恢复为术后(-2.72±0.21)cm、(-2.74±0.19)cm、(-6.60±2.88)cm、(-2.50±0.69)cm、(-2.37±1.08)cm。PFIQ-7、PFDI-20评分由术前(33.71±11.12)、(49.69±10.02)分恢复为(2.01±6.11)、(3.03±10.02)分,I-QOL评分由术前(79.40±27.64)分提高到(106.96±13.02)分(P0.001)。结论:腹腔镜子宫/阴道骶骨固定术可恢复盆腔脱垂患者POP-Q正常解剖结构,显著提高患者的生活质量及性生活质量,客观满意度高,治疗效果满意。     

腹腔镜下腹股沟韧带悬吊术治疗中重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜下腹股沟韧带悬吊术(LILS)治疗中重度盆腔器官脱垂(POP)的临床疗效。方法:自2014年5月至2016年4月,收集上海市第一妇婴保健院收治的78例中重度子宫脱垂/阴道穹隆脱垂行LILS的患者。记录其围手术期指标如:手术时间、出血量、术中并发症,比较术前及术后12个月POP定量(POP-Q)分度法各指示点,并评价其解剖治愈率及复发率等。通过盆底功能障碍性疾病症状问卷简表(PFDI-20)及POP-尿失禁性生活问卷(PSIQ-12)评价主观治愈率以及术后性功能相关症状改善情况。结果:78例术前POP-Q分度为子宫脱垂/阴道穹隆脱垂Ⅲ～Ⅳ度患者中,行全子宫切除术+LILS 57例,行LILS患者21例。平均手术时间130.5分钟(82～190分钟),术中平均出血量51.3 ml(5～200 ml),平均住院时间6.2天(4～8天)。术中无严重的并发症发生。所有的患者获得至少12个月的随访,其客观治愈率93.6%(73/78),总复发率6.4%(5/78)。术后PFDI-20评分较术前明显提高,差异均有统计学意义(P0.05)。PSIQ-12评分及有性生活患者的数量较术前明显提高,差异均有统计学意义(P0.05)。结论:LILS用于治疗中重度POP的患者,其主客观治愈率高、手术并发症少、近期效果及性生活质量明显提高,远期疗效有待进一步研究。     

腹腔镜子宫和附件切除术

回顾性分析无生殖器脱垂妇女需行全子宫和双附件切除术时,腹腔镜外科是否能降低剖腹术率。 从1993年1月～1995年12月,96例无生殖器脱垂、盆底组织松弛或压迫性尿失禁,计划行全子宫伴单侧或双侧附件切除术者,平均年龄51.2±7.5岁,平均产次1.8±1.9。43例(44.8%)为绝经后     

部分可吸收Y型网片应用于腹腔镜下阴道骶骨固定术的临床疗效

目的:分析部分可吸收Y型网片应用于腹腔镜下阴道骶骨固定术(LSC)的临床疗效,评价其对盆腔器官脱垂(POP)治疗的有效性和安全性。方法:回顾分析2014年8月至2016年10月在南方医科大学附属深圳市妇幼保健院因POP使用部分可吸收网片行LSC术的43例患者的临床资料。随访患者术后3、6、9、12个月时的网片暴露、异物感差异,以及手术前、后盆腔器官脱垂定量(POP-Q)分度法各指示点位置,评价总体主观、客观治愈率及复发率。通过盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)、盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评价术后生活质量、性生活改善情况。结果:43例患者术后POP-Q各指示点可达解剖复位,总体主观治愈率100%,总复发率2.3%。术后随访3、6、9、12个月时,患者POP-Q各指示点及相关问卷评分比较,差异均无统计学意义(P0.05),与术前相比,术后阴道长度无明显缩短(P0.05),CRADI-8评分无明显改变(P0.05)。1例压力性尿失禁(SUI)患者行LSC同时行经耻骨后无张力尿道中段悬吊带术(TVT-E),术后尿失禁治愈;2例SUI、1例急迫性尿失禁(UUI)、1例混合性尿失禁(MUI)未行TVT-E治疗,1例在LSC术后症状消失,3例症状程度无改变。结论:部分可吸收Y型网片应用于LSC的主、客观治愈率高,不仅达到解剖学复位,还能显著提高患者的术后生活质量,术后疗效稳定,术后阴道长度无明显缩短,异物感发生率低。部分可吸收网片为LSC的材料植入提供了一种新的选择。     

子宫切除后发生输卵管脱垂的危险因素分析

目的:探讨子宫切除术后输卵管脱垂(FTP)的发生情况及其危险因素。方法:回顾分析2006年1月~2014年3月在陕西中医学院第二附属医院因良性疾病行全子宫切除术的4210例患者的资料,对可能引起术后FTP的相关因素进行单因素分析及Logistic多因素回归分析。结果:4210例患者中,31例(0.74%)发生FTP。单因素分析结果显示,贫血、术中阴道放置引流管、术后2周内重体力活动、术后感染与子宫切除术后FTP的发生相关(P0.05)。多因素分析结果显示,贫血(OR=3.703,95%CI=1.057~12.981)、术中阴道放置引流管(OR=6.745,95%CI=1.856~24.512)、术后2周内重体力活动(OR=3.809,95%CI=1.125~12.891)是子宫切除术后FTP的危险因素。结论:子宫切除术后FTP的发生与贫血、术中阴道放置引流管、术后2周重体力活动有关。应针对这些危险因素预防这一并发症的发生。     

盆腔器官脱垂术后压力性尿失禁加重或新发的影响因素研究

目的探讨盆腔器官脱垂(POP)重建术后压力性尿失禁(SUI)加重或新发的影响因素。方法回顾性分析2008年1月至2017年12月因POP分期Ⅱ～Ⅳ期于北京大学第一医院行盆底重建手术并完成随访的613例患者的临床资料。根据POP患者术前、术后SUI的发生情况,分为术后SUI症状缓解组(270例)和进展组(99例)。采用多因素logistic回归分析术后SUI症状加重或新发的独立危险因素。结果 613例患者中,术前存在显性SUI症状314例(51.22%,314/613),其中192例(61.15%,192/314)术后症状消失,122例(38.85%,122/314)术后仍存在SUI症状,术后新发SUI 80例(26.76%,80/299);高龄、术前尿动力学检查提示最大尿道闭合压低、隐匿性SUI及尿道梗阻是盆底重建术后SUI加重或新发的独立危险因素(P 0.05);盆底重建手术联合抗尿失禁手术是术后SUI的保护因素(P 0.05)。结论对于存在术后SUI加重或新发高危因素的POP患者,术前应综合评估,制定合理的手术方案,必要时同时行抗尿失禁手术。     

河北省部分地区女性尿失禁流行病学调查

目的:研究河北省部分地区女性不同类型尿失禁(UI)的患病现状及影响因素,为临床防治工作提供依据。方法:用分层整群抽样法,抽取河北省石家庄、保定、邢台3个地区的城市和农村,年龄在20周岁以上不同职业的女性2500人,通过面对面问卷方式进行调查。数据录入和分析使用SPSS13.0统计软件完成。结果:合格问卷2448份,城市1485份,农村963份。河北省3个地区女性尿失禁患病率35.2%(862/2448)。其中,压力性尿失禁(SUI)、急迫性尿失禁(UUI)、混合性尿失禁(MUI)患病率分别是26.4%(647/2448)、1.9%(47/2448)和6.9%(168/2448),构成比分别是75.1%、5.4%和19.5%。年龄、便秘、盆腔器官脱垂、流产次数、剖宫产是SUI和MUI的共同影响因素;此外,SUI与体重指数、痛经、妇科炎症、胎儿体重、难产密切相关,MUI与居住地(城乡)、盆腔手术史、泌尿系感染、呼吸系统疾病、心脏疾病、饮酒密切相关。UUI的影响因素只有初潮年龄和难产。结论:尿失禁是调查地区女性的高发病,SUI是主要的患病类型。该病发生与多种因素有关,3种类型尿失禁的影响因素既有共同点,又存在差异,MUI并非SUI和UUI影响因素的简单相加。     

Resolution of urge urinary incontinence with midurethral sling surgery in patients with mixed incontinence and low-pressure urethra

The aim of the study was to determine the rate of persistence of urgency or urge urinary incontinence following midurethral sling surgery compared to standard medication treatment in patients with mixed incontinence and ISD urethra. A prospective study was conducted at a tertiary referral Urogynecology Center. One hundred five women with stress urinary incontinence (SUI) and urgency were identified. Fifty-four consecutive women with SUI and urgency who underwent midurethral sling were compared to 51 women with SUI and urgency but treated with medications first. Women with persistent urgency or urge urinary incontinence (UUI) at 6-month follow-up following a TVT sling procedure were compared with those whose symptoms had resolved, to determine the risk factors for persistent symptoms. Forty out of 54 patients in the operation group also underwent a prolapse repair, either a colpopexy or a colpocleisis. All patients had demonstrated a mean urethral closure pressure of 20?mmHg or lower, indicating an intrinsic sphincteric deficiency. Persistent urgency (6 of 54, 11%) and UUI (3 of 54, 5.5%) were found in patients with mixed incontinence who underwent a sling operation. All 51 patients (100%) persisted with some urgency and urge incontinence despite anticholinergic medication treatment, only (7 of 51, 13.7%) reporting improvement of symptoms. Concomitant prolapse surgery, especially apical correction (OR 0.55, 95% CI 0.37–0.65), decreased the risk of urgency persistence, while age (OR 1.04, 95% CI 1.02–1.05), detrusor overactivity (OR 1.66, 95% CI 1.28–2.53), baseline symptom severity (OR 1.77, 95% CI 1.48–2.36), and previous incontinence surgery (OR 2.08, 95% CI 1.38–3.60) increased the risk of persistent urgency in the operated cohort. Women were happier in the operated cohort (45 of 54, 83.3% cure rate). A sling itself decreased the risk of persistent urge or UUI (OR 0.33, 95% CI 0.15–0.70). The most significant improvement was UUI at night. Urodynamic parameters, baseline urgency symptom severity, age, and concomitant prolapse operation are important predictors of persistent urgency or UUI following midurethral sling for mixed incontinence patients.     

Short- and long-term results of the tension-free vaginal tape procedure in the treatment of female urinary incontinence

BACKGROUND: The aim was to describe the short- and long-term results of treatment for urinary incontinence (UI) in women using the tension-free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. MATERIAL AND METHODS: Consecutive female patients (n = 707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n = 59). Factors influencing the cure rate were analyzed using multiple regression analysis. RESULTS: The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30+/-9 min (mean+/-SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. CONCLUSIONS: The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.     

分娩方式对产后妇女粪失禁及尿失禁的影响

目的 调查女性产后粪失禁和尿失禁的发生率及其相关因素.方法 电话随访2006年10月1日至2007年9月30日在北京大学第一医院妇产科分娩的产妇,共纳入2012例妇女,收集其产后6个月内粪失禁和尿失禁的症状.采用Logistic回归法分析分娩方式与尿失禁和粪失禁的关系.结果 (1)参与调查的2012例产后妇女,14例(0.70％)有粪失禁症状.Logistic回归分析显示,粪失禁与阴道产钳助产(OR=20.09,95％ CI:3.64～110.90,P=0.000)和会阴侧切术分娩相关(OR=6.11,95％ CI:1.29～28.80,P=0.024).(2)2012例妇女中产后尿失禁、压力性尿失禁(stress urinary incontinence,SUI)、急迫性尿失禁(urge urinary incontinence,UUI)、混合性尿失禁(mixed urinary incontinence,MUI)的发病率分别为10.04％(202例)、8.15％ (164例)、0.94％(19例)和0.94％(19例).Logistic回归分析显示,与SUI相关的因素有:母亲年龄(OR=1.07,95％ CI:1.04～1.11,P=0.000)、母亲分娩前体重(OR=1.04,95％CI:1.02～1.06,P=0.001)、新生儿头围(OR=1.20,95％ CI:1.05～1.39,P=0.010)、会阴侧切术分娩(OR=4.96,95％ CI:3.05～8.07,P=0.0005)、阴道自然分娩(OR=5.22,95％ CI:2.53～10.76,P=0.000)和阴道产钳助产(OR=9.20,95％ CI:4.07～20.79,P=0.000).与UUI相关的因素有:产妇分娩前体重(OR=1.51,95％CI:1.12～2.05,P=0.008).与MUI相关的因素有:产妇分娩前体重(OR=1.06,95％ CI:1.00～1.11,P=0.049)、第二产程时限(OR=1.01,95％ CI:1.00～1.03,P=0.010)、会阴侧切术分娩(OR=7.76,95％ CI:1.42～42.52,P=0.017)和阴道产钳助产(OR=15.21,95％ CI:1.61～143.44,P=0.018).(3)产后4d和产后42 d SUI的发病率较高分别为7.95％和9.10％.结论 (1)本院产后妇女粪失禁和尿失禁的发病率较先前报道的其他地区的发病率低.(2)阴道分娩是妇女产后粪失禁和尿失禁发生的高危因素,特别是阴道产钳助产和会阴侧切术分娩.(3)母亲的年龄、分娩前体重、新生儿出生时头围、阴道自然分娩、产钳助产、会阴侧切术是发生尿失禁的高危因素.     

北京郊区女性尿失禁及盆腔脏器脱垂发病情况及其对生活质量影响的抽样调查

目的 调查北京郊区女性尿失禁及盆腔器官脱垂发病情况及其对生活质量的影响。方法 按照整群抽样的方法，选取生活在北京市房山区某自然村18岁以上的常住已婚女性，进行问卷调查，并行妇科检查和B超检查。结果 全村符合调查的女性202人，回收问卷190份，应答率94．1％。调查结果显示，尿失禁的患病率为67例（35．3％）。子宫脱垂49例（25．8％），阴道前壁膨出79例（41．6％），阴道后壁膨出61例（32．1％）。尿失禁对女性日常生活、情绪和性生活的影响率分别为29．9％、23．9％、29．9％，尿失禁以轻度尿失禁为主（占82．1％），尿失禁合并子宫脱垂占31．3％，合并阴道前壁膨出59．7％，合并阴道后壁膨出44．8％。结论 整群抽样调查显示，北京郊区女性尿失禁及盆腔脏器脱垂均较常见，尿失禁患者多合并盆腔脏器脱垂，尤其是阴道前壁膨出，并对生活质量有较大影响。     

Transurethral polydimethylsiloxane injection: a valid minimally invasive option for the treatment of postradical hysterectomy urinary incontinence

Urinary incontinence (UI) is a common complication after radical hysterectomy, ranging between 21% and 53%. Two cases of postradical hysterectomy UI treated with transurethral macroplastique injection are reported here. At 1-year follow-up, 1 patient showed no episodes of incontinence in voiding diary. The second patient showed a positive cough stress test only in standing position at 400 mL of bladder emptying. The frequency of UI according to a 3-day voiding diary was 3 episodes. Preoperative and postoperative subjective patient perception of UI symptom severity (visual analog scale) was 7-0 and 8-2 for cases 1 and 2, respectively. Bulking agents urethral injection could be a minimally invasive option to improve well-being of patients with cervical cancer after radical surgery.     

阴道前壁组织中TGF-β1的表达与SUI的关联性研究

目的：探讨阴道前壁组织中TGF—β1的表达与SUI的关联性研究。方法：采用免疫组化方法,测定30例压力性尿失禁患者（sut组）,并选择同期20例妇科良性病变而行子宫切除术者作为对照（对照组）,于手术中取患者阴道前壁,采用免疫组织化学方法观察TGF—β1的表达。结果：TGF—p1在SUI组着色低、分布稀疏,表达均低于正常对照组（P〈0．05）。结论：TGF-β1可能通过减少Ⅲ型胶原的合成而导致SUI的发生。     

Coital Incontinence in Women With Urinary Incontinence: An International Study

Introduction

Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem.

盆腔器官脱垂手术对下尿路症状影响的前瞻性研究

目的 探讨盆腔器官脱垂患者盆底修复手术后下尿路症状的变化情况,以及术中加行经闭孔尿道中段无张力悬吊带术(TVT-O)对漏尿及下尿路症状的影响.方法 2007年1月至2009年12月期间,共193例盆腔器官脱垂患者在北京大学第一医院行盆底修复手术(其中131例加行TVT-O)且术后随访达3个月以上,前瞻性研究患者手术后的下尿路症状变化情况及术后尿失禁症状的影响因素.结果 (1)193例患者中有下尿路症状者术前为85.5%(165/193),术后为54.4%(105/193),术后下尿路症状总体发生率低于术前,手术前后比较,差异有统计学意义(P＜0.01).(2)手术前后下尿路症状及相关症状发生率,尿频分别为57.0%、25.9%,尿急分别为51.8%、28.0%,咳嗽漏尿分别为50.3%、15.0%,点滴漏尿分别为44.6%、14.5%,排尿困难分别为34.7%、23.3%,排尿不尽分别为49.2%、19.7%,手助排尿分别为31.1%、2.6%,术后各症状的发生率均明显低于术前,分别比较,差异均有统计学意义(P＜0.05).(3)对于术前有漏尿症状的患者,盆底修复手术的同时未行TVT-O是术后漏尿症状不改善的高危因素(OR=4.933,95%CI为1.353～17.990,P=0.016).结论 盆底修复手术对盆腔器官脱垂患者的下尿路症状有改善作用.对于术前有漏尿症状的患者,加用TVT-O手术比单纯盆底修复手术能更有效地治疗其漏尿症状.

Abstract：

Objective To investigate effect of urinary conditions and lower urinary tract symptoms (LUTS) in patients before and after the reconstructive pelvic surgery (RPS) for pelvic organ prolapse (POP) as well as effect of urinary conditions and LUTS by tension-free vaginal tape-obturator (TVT-O).Methods From Jan. 2007 to Dec. 2009, 213 patients with POP underwent RPS, the factors on preoperative, postoperative urinary conditions and qualities of life and postoperative urinary incontinence were studied prospectively. Results Totally 193 patients who was followed up for more than 3 months after surgery attend questionnaires, and 165 preoperative patients of 193 (85.5%) had LUTS, 105 postoperative patients of 193 (54.4%) had LUTS, which reached statistical difference (P ＜0. 01 ). The rate of LUTS before and after operation: urinary frequency ( 57.0% and 25.9% ), urinary urgency ( 51.8% and 28.0% ), urinary leakage due to cough ( 50. 3% and 15.0% ), dropping urinary leakage ( 44. 6% and 14. 5% ), dysuria (34. 7% and 23.3% ), vesicaltenesmus (49.2% and 19. 7% ) and hand assist urination (31.1% and 2.6% ). The incidence of LUTS after surgery is much lower than that of pre-operation ( P ＜0. 05 ). POP patients with stress urinary incontinence ( SUI ) before the operation, surgery without TVT-O simultaneously are the risk factors of unimproved symptom ( OR = 4. 933, 95% CI: 1. 353 - 17. 990, P=0. 016). Conclusions RPS have alleviated LUTS in patients with POP. RPS with TVT-O are more effective than traditional RPS in treatment of the urinary incontinence if the POP patient with SUI or occult SUI.     

Occult stress incontinence in women with pelvic organ prolapse.

OBJECTIVES: To study the prevalence of occult stress urinary incontinence (SUI) among Indian women with genitourinary prolapse, and determine the risk of developing SUI after vaginal hysterectomy and pelvic floor repair in Indian women with occult SUI. METHODS: A prospective cohort study of 78 women with significant genitourinary prolapse without symptoms of SUI was conducted at Christian Medical College, Vellore, India. Before the surgical intervention, the prolapse was repositioned using a pessary and a Pyridium (Parke Davis, Morris Plains, NJ, USA) pad test was performed to detect occult SUI. The primary outcome studied was the risk of developing postoperative urinary incontinence. RESULTS: Preoperatively, 67.9% of women were found to have occult SUI. The prevalence of SUI was 43.6% postoperatively, and 64.2% of the women with a positive result to the preoperative Pyridium pad test after pessary insertion were found to have urinary incontinence postoperatively. Postmenopausal women had twice the risk of developing occult SUI. CONCLUSION: Preoperative testing is useful to identify women with genitourinary prolapse who have occult SUI. Women with a positive result may need a systematic clinical evaluation and urodynamic studies to characterize the incontinence. They can be then counseled preoperatively regarding concomitant anti-incontinence procedures.