女性压力性尿失禁风险预测的研究进展

综述女性压力性尿失禁(stress urinary incontinence,SUI)风险预测的研究进展。指出女性SUI风险预测相关文献普遍存在风险预测工具和指标缺乏临床大样本验证,指标、纳入人群不统一的现象,风险预测模型存在构建过程未按报告规范进行,未进行完整的模型验证以及模型性能评价指标不规范的情况。未来研究可以在现有风险预测工具或模型的基础上进行改进、完善,以期为女性SUI风险预测提供参考。     

电刺激联合生物反馈治疗产后SUI疗效及影响因素分析

目的 对比产后压力性尿失禁(SUI)的3种治疗方法的疗效及分析电刺激治疗效果的影响因素.方法 选取2016年2月至2017年2月于产后6周至湖州市妇幼保健院妇产科进行盆底功能检查的产后SUI产妇120例,根据治疗方法分成A组、B组和C组,A组患者仅给予健康教育,B组患者给予盆底肌锻炼治疗,C组患者给予电刺激联合生物反馈治疗.对比3组患者的SUI分度、盆底肌力、治疗有效率,分析影响电刺激治疗效果的因素.结果 经Fisher确切概率法检验,3组患者的总有效率比较有显著性差异(P=0.000<0.05),进一步每两组之间比较发现,A组有效率显著高于B组和C组(均P=0.000<0.05),B组有效率显著高于C组(P=0.012<0.05).3组患者治疗前的盆底肌力经Fisher确切概率法检验,差异无统计学意义(P=0.994>0.05),3组患者治疗后的盆底肌力差异具有统计学意义(χ2=21.641,P<0.05),B组患者治疗后的盆底肌力优于A组,C组治疗后的盆底肌力优于B组患者.多因素分析显示,产后抑郁程度、SUI严重程度、孕期体重增加量是电刺激治疗效果的影响因素(OR值分别为4.162、5.772、5.323,均P<0.05).结论 电刺激联合生物反馈治疗效果最优,可广泛应用;孕期体重增加量是电刺激治疗效果的影响因素,通过控制孕期体重可提高产后SUI电刺激的治疗效果.     

Comparison of outcomes between single‐incision sling and transobturator sling for treating stress urinary incontinence: A 10‐year prospective study

Aims: To evaluate and compare the clinical outcomes of the transobturator sling with the single‐incision sling, for the treatment of stress urinary incontinence at a long‐term follow‐up. Methods: From October 2008 to October 2010, 94 patients who were enrolled and underwent either TVT‐O, one of standard mid‐urethral sling or TVT‐S, one of single‐incision mini‐sling (SIMS) procedure. The study population was followed until February 2019. Surgical outcomes were analyzed by subjective and objective evaluations and Chinese version questionnaires. Data were analyzed by IBM 23.0 SPSS Statistics. The level of statistical significance was set at P < 0.05. Results: At the 10‐year follow‐up, 31(64.6%) TVT‐O patients and 33(71.7%) TVT‐S patients were still available. Objective cure and subjective satisfaction rate were not significantly different for TVT‐O compared with TVT‐S (P > 0.05). However, TVT‐S showed a greater drop in success from the second to the tenth year compared with TVT‐O (15.1% vs 0% and 9.2% vs 3.2%, respectively). Both groups experienced significantly improved quality of life in the TVT‐O group and in the TVT‐S group (P < 0.05). The total PISQ‐12 scores at 10 years postoperatively of the TVT‐O and TVT‐S groups were 33.4(4.7) compared with 33.6(3.9) before surgery (P = 0.67 > 0.05) and 35.5(5.9) compared with 31.5(6.3) before surgery (P = 0.045 < 0.05). Conclusions: It is difficult to state that there is superiority of one sling over another sling without a significant difference. But TVT‐O showed superior objective cure and subjective satisfaction rates and a less decline in success during 10 years compared with TVT‐S.     

压力性尿失禁动物模型的建立及效果评价

背景：目前治疗压力性尿失禁的方法有药物治疗、物理-行为治疗及手术治疗等多种,但仍在探索优化中。 目的：探索通过截断双侧阴部神经及支配髂骨尾骨肌、耻骨尾骨肌的盆底神经肌友,建立稳定的压力性尿失禁动物模型的方法。 方法：6周龄SD雌性大鼠18只,体质量(199.44±8.41) g。随机分为3组,正常组、模型组和假手术组各6只。对模型组大鼠作双侧阴部神经及盆底神经肌支截断,假手术组分离暴露上述神经但不作截断,正常组大鼠不作特殊处理。术后2周测定3组大鼠的漏尿点压力。压力测定后取正常大鼠及模型大鼠的膀胱颈尿道交界部的横截面作组织学分析。 结果与结论：假手术组1只大鼠于术后1周死亡。余大鼠皆存活并顺利测定漏尿点压力。与正常大鼠相比,模型组大鼠平均漏尿点压力下降约33%(P < 0.05),而假手术组大鼠与正常组大鼠平均漏尿点压力差异无显著性意义(P > 0.05)。组织学检查显示,与正常大鼠比较,模型组大鼠尿道横纹肌排列疏松,而肌纤维也出现一定的萎缩。提示截断双侧阴部神经及盆底神经肌支可建立较为稳定的压力性尿失禁动物模型。     

Midterm prospective comparison of vaginal repair with mesh vs Prolift system devices for prolapse

Objective

To compare midterm clinical outcome using modified pelvic floor reconstructive surgery with mesh (MPFR) vs Prolift devices for the treatment of pelvic organ prolapse (POP).

Study design

This prospective observational cohort study involved 223 women with POP stages III–IV who were assigned to either MPFR (n = 131) or Prolift device (n = 92). Outcomes were analyzed at 6 and 12 months and the last follow-up visit postoperatively. Main outcome measures included pelvic organ prolapse quantification measurement, Short Form-20 Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) questionnaires, perioperative outcomes, complications, and a personal interview about urinary and sexual symptoms. Statistical analysis included comparison of means (Wilcoxon test or Student's t-test) and proportions (Chi-square test). Multivariate analysis was carried out using Cox proportional hazard model.

Results

At follow-up (median, 36 months; range, 17–58 months), anatomic success for MPFR and Prolift was 87.07% and 93.41%, respectively (P = 0.1339). Both operations significantly improved quality of life, and PFDI-20 scores were lower in the Prolift group than the MPFR group (P = 0.03). Complication rates did not differ significantly between the two groups and the prevalence of urinary symptoms decreased postoperatively in both groups. The cost of operation, however, was RMB ¥11,882.86 yuan for MPFR and ¥23,617.59 yuan for Prolift (P = 0.00).

Conclusions

MPFR and Prolift had comparable anatomic outcomes, Prolift had better functional outcomes than MPFR, but MPFR is much cheaper than Prolift. MPFR is an alternative, cheap and effective surgical treatment option to mesh-kits for the management for POP.     

SUI患者盆底支持组织中MMP-3、TIMP-3、TGF-β1和CollagenⅢ表达的研究进展

女性压力性尿失禁（SUI）是一种常见病,但其发病机制目前尚无确切定论。近年来,试图通过研究SUI患者盆底支持组织中功能成分表达的病理性变化以探索SUI发病机制及相关治疗措施,已成为该领域的研究热点。该文综述了基质金属蛋白酶-3（MMP-3）、组织源性金属蛋白酶抑制剂-3（TIMP-3）、胶原（Collagen）Ⅲ、转化生长因子β1（TGF-β1）在SUI疾病发生、演化发展中的作用。     

疾病不确定感对中老年压力性尿失禁妇女一般自我效能感评分的影响

目的:探讨疾病不确定感对中老年压力性尿失禁(SUI)妇女一般自我效能感(GSE)评分的影响。方法:选择近期来我院就诊的中老年SUI妇女137例,分别应用Missals疾病不确定感量表和一般自我效能感量表(GSES)进行评估,并与随机抽取的46例同期进行健康体检妇女的测试结果比较。结果:中老年SUI妇女的疾病不确定感量表各维度得分及总分均明显高于健康体检妇女(P<0.01);中老年SUI妇女GSES各问题得分及总分明显低于健康体检妇女(P<0.01,P<0.05);且疾病不确定感水平越高,GSES各问题得分及总分越低(P<0.01,P<0.05)。结论:中老年SUI妇女疾病不确定感得分与GSES评分呈负相关,医护人员应及时对患者疾病不确定感进行评估,并采取相应干预措施以提高患者一般自我效能。     

盆底动态核磁共振在女性压力性尿失禁合并盆腔器官脱垂患者诊断评估中的临床价值

目的探讨盆底动态核磁共振(dynamic magnetic resonance imaging,dMRI)在女性压力性尿失禁(stress urinary incontinence,SUI)合并盆腔器官脱垂(pelvic organ prolapse,POP)患者中的鉴别和诊断的价值。方法选取2018年2月至2019年2月恩施州中心医院妇科经查体确诊的35例SUI合并POP患者和同期同年龄段的25例SUI患者为研究对象。将35例SUI合并POP患者设为观察组,25例SUI患者设为对照组。两组患者均行1.5T dMRI检查和经会阴超声检查,从横断位、矢状位、冠状位影像,测量其膀胱尿道后角、尿道长度、尿道倾斜角、H线和盆膈裂孔横径指标情况;分析比较dMRI在单纯SUI和SUI合并POP中的鉴别和诊断价值,探究dMRI检查与POP分级的一致性情况。结果观察组和对照组患者静息相经会阴超声、dMRI诊断的尿道长度、膀胱尿道后角、尿道倾斜角、α角等参数比较,其差异均无统计学意义(均P>0.05);两组患者力排相dMRI检查测量的膀胱尿道后角、α角略高于超声测量数据,其差异均具有统计学意义(均P<0.05)。观察组患者dMRI静息相、力排相H线、盆膈裂孔横径2项参数差异均具有统计学意义(均P<0.05);dMRI在诊断观察组前盆腔、中盆腔脏器脱垂严重程度与POP-Q体格检查一致性良好。结论 dMRI相对于传统经会阴超声诊断技术在SUI合并POP检查中,可以更精确地测量盆底相关参数,清晰显示盆底支持结构功能状态,可以准确鉴别SUI、SUI合并POP,并且准确评估盆腔脏器脱垂程度,值得临床推广应用。