同期手术治疗女性压力性尿失禁与盆腔脏器脱垂的临床研究

目的 探讨同期手术治疗女性压力性尿失禁(SUI)与盆腔脏器脱垂(POP)的适应证及治疗效果.方法 回顾性总结16例同期手术治疗SUI与POP患者的病例资料,其中有SUI症状并伴有中度以上阴道前壁膨出的患者12例,主诉阴道脱出物,检查发现子宫中度以上脱垂伴排尿困难4例,术前经查体、尿动力及膀胱造影检查确诊均存在Ⅱ型SUI.盆底修补手术包括Gynemesh网片、Prolift前片及全片植入,抗尿失禁手术采用TVT或TVT-O术,术中先行盆底修补术.结果 随访6～30个月,全部患者获满意效果,达到完全控尿,同时无排尿困难发生,未发现盆底膨出复发.结论 对合并有症状或中度以上POP的SUI患者,应积极同期处理相应的POP,以免加重POP的程度或排尿困难的发生;对单独发生的POP患者,应警惕隐性SUI的可能,同期行相应的控尿手术可避免术后SUI的发生.

Clinical study on concomitant surgery for stress urinary incontinence and pelvic organ prolapse

Objective To discuss indications and therapeutic effects of concomitant surgery for stress urinary incontinence(SUI)and pelvic organ prolapse(POP)through a retrospective clinical review.Method A retrospective review ofthe data of 16 women undergoing concomitant surgery for SUI and POP WaS available for analysis.In these cases.12 patients presented with SUI symptoms associated with medemte or Severe anterior vaginal wall prolapse;4 patients had moderate or severe uterine prolapse associated with dySUXia.All cases were confirmed to have type II stress urinary incontinence by preoperative physical examination,uredynamic study and cystography.The surgical procedures for pelvic floor repair included the placement of Gynemesh mesh impant.anterior or total Prolift mesh implant.The tension-free vaginal tape (TVT)or transvaginal tension free vaginal tape-obturator(TVT-O)was used for the anti-incontinence procedure.During the concurrent surgical procedures,pelvic floor repair was performed first.Results Followel up from 6 to 30 months.all cases got satisfactory results.After the procedure,the patients achieved complere continence without occurrence of dysuria or recurrence of POP.Conclusions Stress inconfinence and pelvic organ prolapse share common pathophysiologic etiologies and often coexist with one another. In SUI patients with symptomatic or mederate to severe POP,concurrent POP surgery shoed be performed actively at the time ofincontinence surgery to prevent POP exacerbation and the occurrence ofdysuria;while in padents with sole POP,occult SUI should be eonsidered,and concomitant prophylactic incontinence measures should be taken at the time of POP rear to prevent the postoperative unmasking of SUI.