女性盆底功能障碍性疾病的临床研究进展

女性盆底功能障碍性疾病(pelvic floor dysfunctional disease,PFD)是产后及中老年女性的多发病、常见病,是近年来妇产科领域的研究热点。主要病因为盆腔及生殖道支持组织缺陷、失去正常的支持作用,进而导致盆底结构和功能异常。主要症状和体征包括盆腔器官脱垂(pelvic organ prolapse,POP)、压力性尿失禁(stress urinary incontinence,SUI)以及慢性盆腔疼痛(chronic pelvic pain)等,严重影响女性身心健康和生活质量。该文对女性PFD的病理机制、临床诊断方法及治疗方法的进展进行综述。     

老年女性盆腔器官脱垂的治疗进展

盆腔脏器脱垂指机体盆底肌肉、骨骼支持系统作用逐渐减弱,导致盆腔内直肠、子宫和膀胱等器官组织位置出现下移的一种疾病[1]。其中女性盆腔脏器脱垂(pelvic organ prolapse,POP)作为常见类型之一,指盆腔器官在各种因素影响下导致盆底功能支持薄弱,进而造成盆腔脏器移位,从而自然脱出阴道外。     

压力性尿失禁患者阴道壁组织中MMP-10、TIMP-3和LN的表达及意义

目的观察女性压力性尿失禁（SUI）患者阴道壁组织中基质金属蛋白酶-10（MMP-10）及其抑制剂-3（TIMP-3）和层粘连蛋白（LN）的表达变化,并探讨其意义。方法随机选取40例有完整随访资料的女性SUI患者为SUI组,选取同期30例无压力性尿失禁和盆腔脏器脱垂（POP）的良性妇科病手术患者为对照组,均于术中取患者阴道壁结缔组织,采用免疫组化法检测其中的MMP-10、TIMP-3及LN。结果SUI组MMP-10的表达较对照组明显升高,TIMP-3和LN的表达较对照组明显下降（P〈0．05）。SUI组MMP-10与TIMP-3、LN的表达分别呈负相关（r分别为-0．494、-0．459,P均〈0．05）;TIMP-3与LN的表达呈正相关（r=0．946,P〈0．05）。结论SUI中MMP-10升高及TIMP-3和LN的下降,使胶原代谢活跃,对胶原纤维的降解明显增强。联合检测阴道壁组织中的MMP-10、TIMP-3和LN有助于SUI的诊疗。     

柳州地区女性盆腔脏器脱垂与压力性尿失禁之间的关系

目的研究柳州地区成年女性盆腔脏器脱垂(POP)与压力性尿失禁(SUI)之间的关系。方法采取整群抽样的方法选择在柳州市和下辖7个县的妇幼保健院就诊或住院的1 807例20周岁以上女性为研究对象,对其进行问卷调查以及妇科检查(POP-Q分期法),分析POP与SUI之间的关系。结果 1 807人中阴道前壁膨出者为1 424人,子宫脱垂者为1 144人,阴道后壁膨出者281人,POP患者中SUI患病率为51.3%,其中SUI在阴道前壁膨出、子宫脱垂和阴道后壁膨出的患者中患病率分别为18.2%、18.5%和22.1%。SUI患病率在四种阴道前壁膨出程度间差异有统计学意义(P0.01),且患病率随阴道前壁膨出程度增加而升高(P0.01)。不同子宫脱垂程度间SUI患病率差异有统计学意义(P0.01),且患病率随子宫脱垂程度增加而升高(P0.01)。但各组阴道后壁膨出间SUI患病率差异无统计学意义(P0.05)。结论阴道后壁膨出、阴道前壁膨出和子宫脱垂的病情越严重,并发SUI的危险性越大。     

盆腔器官脱垂的动态MRI研究进展

盆腔器官脱垂(pelvic organ prolapse,POP)是指由于盆底支持结构薄弱导致的盆腔器官疝出.动态MRI为无放射性、无创、快捷、全面、高分辨率的检查方法,其软组织对比性强,可清晰显示静息位及动态位时盆底肌肉和筋膜组织结构及功能上的变化,了解盆腔多组织器官的状况,为临床提供客观影像学数据.动态MRI常用于...     

盆底超声联合尿动力学检查对老年女性盆腔脏器脱垂的诊断价值

目的评估盆底超声联合尿动力学检查对老年女性盆腔脏器脱垂(POP)的诊断价值。方法选取2018年1月至2020年6月到海南省妇女儿童医学中心就诊的60例老年POP患者为POP组,并将20例同期就诊的阴道炎患者作为对照组。对POP患者进行尿动力学检查,且依据国际尿控协会(ICS)的盆腔脏器脱垂分期法(POP-Q)对POP患者进行分期。同时对POP患者和志愿者进行盆底超声,检查其在静息状态和最大Valsalva动作时近端尿道与膀胱后壁的夹角(α)、上段尿道与人体纵轴的夹角(β)、膀胱颈到耻骨联合下缘-腹背侧水平线的垂直距离(L)及最大幅度Valsalva动作时膀胱颈移动度(BND)。分析盆底超声和POP-Q检查阴道前壁(Aa)点位置的相关性。结果对60例患者进行了POP-Q分期;尿动力学检查结果显示52例POP组有阴道前壁脱垂、45例有阴道后壁脱垂、37例有子宫脱垂、14例伴有膀胱出口梗阻、16例伴有逼尿肌异常、18例伴有膀胱功能异常。超声结果显示不同POP-Q分期患者的α角、β角、L及BND差异无统计学意义(P>0.05),对照组和POP组超声指标差异有统计学意义(P<0.05)。盆底超声测量值和POP-Q分期与Aa点位置的检测结果具有良好的相关性。结论尿动力学检查和盆底超声对老年POP都具有诊断价值,两者结合可以提高检查的精准性,为老年女性POP的手术方案和术后护理提供可靠的依据。     

老年女性盆底手术治疗的相关进展

正盆底功能障碍性疾病(PFD)是老年女性的常见疾病,由于盆底支撑组织薄弱或缺损使得盆腔脏器的位置或功能发生异常,多表现为:盆腔脏器脱垂(POP)、压力性尿失禁(SUI)、粪失禁(FI)以及性功能障碍(SD)等,临床尤以POP和SUI最为常见。目前认为,年龄、肥胖、分娩损伤、雌激素水平下降,慢性咳嗽、便秘等长期腹压增加均是造成     

无张力阴道吊带术治疗女性压力性尿失禁13例疗效观察

目的探讨无张力阴道吊带术（TVT）治疗女性压力性尿失禁（SUI）的临床效果和常见并发症。方法对13例女性SUI患者行TVT。观察手术效果。结果 10例患者术后即可自行排尿。2例术中出现尿道破裂,术后留置尿管1周,恢复良好。术后2例患者拔除尿管后出现急性尿潴留,经扩张尿道,保留导尿后恢复正常排尿。本组随访3～9个月,均无复发。结论 TVT治疗女性SUI效果确切,安全可靠,并发症发生率低。     

女性压力性尿失禁的尿流动力学检查及意义

压力性尿失禁（SUI）是妇女（尤其是中老年妇女）的常见疾病，可严重影响患者的生活质量。90％的SUI是解剖型SUI，系指患者腹压突然增高时尿液不自主地自尿道口流出。根据其发病机制，SUI可分为两类、三型：第一类为尿道移动度增加，因盆底松弛，膀胱颈及近段尿道下移，当腹压增高时，压力不能传递到近段尿道，而使原来的尿道膀胱压力梯度不复存在．发生漏尿。此类中根据尿道移动程度又可分为两型：尿道和膀胱颈下降〈2cm为Ⅰ型，否则为Ⅱ型。第二类为尿道内括约肌缺陷（即Ⅲ型），由于盆腔广泛手术、尿道手术或损伤，或神经性病变等。使近段尿道和膀胱颈对合不良而长期处于开放状态，当腹压增高时即致漏尿。尿流动力学检查是通过尿动力学仪检测储尿期和排尿期整个膀胱和尿道的压力、     

全骨盆底悬吊术在女性骨盆底功能重建中的应用

目的探讨利用全骨盆底网片悬吊术治疗女性盆腔脏器脱垂并进行骨盆底重建的可行性和有效性。方法对2005年1月至2006年6月确诊为盆腔脏器脱垂的53例患者采用蝶形聚丙烯网片进行经阴道全骨盆底悬吊术,根据临床检查及主诉对手术前后脱垂情况进行评估,观察疗效并定期随访。结果手术时间平均97min,出血量平均160ml,53例均在术后2～6d出院,术后1、3、9、12个月随访,根据国际尿控协会制定的盆腔脏器脱垂定量分度法客观评估子宫脱垂、阴道前后壁膨出等症状全部得到纠正,无复发、无阴道扭曲和缩短、无性生活障碍,满意度达94．3％。结论全骨盆底网片悬吊术是经阴道的微创手术,对盆腔脏器脱垂患者在保留子宫的同时进行骨盆底功能重建,复发率低,值得临床进一步推广。     

阴道全封闭术治疗老年女性盆腔器官脱垂的疗效

目的 分析老年女性盆腔器官脱垂(POP)患者实施阴道全封闭术的临床疗效及安全性.方法 选取2012年1月至2018年1月在佛山市妇幼保健院妇科住院治疗、盆腔器官脱垂分期法(POP-Q)评定为Ⅲ～Ⅳ期、并接受阴道全封闭术治疗的78例老年POP患者.所有患者治疗后进行1年随访观察,记录术前和术后POP-Q分期情况.分析患者...     

Management of pelvic organ prolapse

Symptomatic pelvic organ prolapse can afflict up to 10% of women. Urinary incontinence, voiding dysfunction or difficulty possibly related to bladder outlet obstruction are common symptoms. Infrequently hydronephrosis or defecatory dysfunction can be seen. The management of pelvic organ prolapse (POP) should start with adequate assessment of all pelvic floor complaints. If a patient is not symptomatic, surgical intervention is usually not indicated. While the use of a variety of graft materials are available today including porcine, dermal and synthetic grafts, that are used in some surgical approaches to pelvic organ prolapse, other more conservative approaches may prove beneficial to many patients. This article describes our approach to the patient with pelvic organ prolapse.     

So the First Pelvic Organ Prolapse Repair Failed…Now What?

Purpose of Review

Surgical repair of pelvic organ prolapse (POP) is common and a significant number of women will experience POP recurrence. This paper provides a summary of management options for recurrent POP.

Recent Findings

Vaginal and abdominal approaches to recurrent POP utilizing native tissues, previously placed mesh, or a new mesh implant are all reasonable options for repair. Choice of surgical approach should be individualized to the patient.

Summary

Without evidence from randomized controlled studies to help clinicians delineate the appropriate repair for each patient, there is still no perfect answer as to the best surgical treatment for recurrent POP. Similar to primary repairs, vaginal and abdominal approaches to recurrent POP utilizing either native tissues or polypropylene mesh (new or previously placed) are all reasonable options for repair. In the hands of an experienced pelvic reconstructive surgeon, complication rates from mesh implantation are limited while potential benefits of additional strength and durability are offered. Debate continues over the appropriate use of polypropylene mesh for pelvic reconstruction in women with prolapse; in the setting of recurrent bothersome prolapse mesh may offer a durable option.

     

The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse

OBJECTIVES: To compare perioperative morbidity and 1-year outcomes of older and younger women undergoing surgery for pelvic organ prolapse (POP). DESIGN: Prospective ancillary analysis. SETTING: Academic medical centers in National Institutes of Health, National Institute of Child Health and Human Development Colpopexy and Urinary Reduction Study. PARTICIPANTS: Women with POP and no symptoms of stress incontinence. INTERVENTION: Abdominal sacrocolpopexy with randomization to receive Burch colposuspension for treatment of possible occult incontinence or not. MEASUREMENTS: Perioperative complications and Pelvic Organ Prolapse Quantification and quality-of-life (QOL) questionnaires (Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Medical Outcomes Study Short-Form Health Survey (SF-36) preoperatively, immediately postoperatively, and 6 weeks and 3 and 12 months postoperatively). RESULTS: Three hundred twenty-two women aged 31 to 82 (21% aged > or =70), 93% white. Older women had higher baseline comorbidity (P<.001) and more severe POP (P=.003). Controlling for prolapse stage and whether Burch was performed, there were no age differences in complication rates. Older women had longer hospital stays (3.1+/-1.0 vs 2.7+/-1.5 days, P=.02) and higher prevalence of incontinence at 6 weeks (54.7% vs 37.2%, P=.005). At 3 and 12 months, there were no differences in self-reported incontinence, stress testing for incontinence, or prolapse stage. Improvements from baseline were significant on all QOL measures but with no age differences. CONCLUSION: Outcomes of prolapse surgery were comparable between older and younger women except that older women had slightly longer hospital stays.     

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febri...     

Pelvic Organ Prolapse-Associated Cystitis

Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance—suggesting that global pelvic floor dysfunction may play a role.     

Quality of Life Questionnaires for the Assessment of Pelvic Organ Prolapse: Use in Clinical Practice

Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic organ prolapse (POP) has become a standard part of most clinical studies. Investigators have attempted to correlate QOL scores with objective findings and treatment efficacy and as outcome measures in comparing different treatment modalities. Many of the QOL questionnaires are available in short forms, making them easier to adapt to clinical settings. This article includes an overview of several validated QOL questionnaires and their application in studies whose results provide useful guidelines for health care professionals who diagnose and manage women with POP.     

How Best to Manage the Posterior Compartment

Urogenital prolapse is a common, distressing condition in women with a significant impact on Quality of life (QoL). Amongst women with pelvic organ prolapse [POP], the posterior compartment is affected in nearly 75 %, although isolated rectoceles are relatively uncommon and are found in approximately 7 % of women who present for surgical repair. Patients with rectoceles may present with an asymptomatic bulge or may have significant complaints ranging from “bulge” symptoms to defecatory and sexual dysfunction. Accordingly, there are several options available for the management of posterior compartment prolapse, from expectant management to surgical repair with or without the use of mesh. The aim of this article is to briefly consider the aetiopathogenesis and symptomatology of posterior compartment prolapse and critically review different management options for this prevalent condition.     

Overactive Bladder Prevalence after Surgery for Pelvic Organ Prolapse

In this review, we set out to address the clinically complex question of how patients with overactive bladder (OAB) syndrome and pelvic organ prolapse (POP) fare with respect to symptomatic improvement after surgical treatment of POP. Our objectives are to use the current literature to define appropriate patient expectations for improvement and cure and to look for factors predicting divergent outcomes, with the goal of offering realistic preoperative patient counseling. Secondary aims include highlighting areas of needed research, defining outcome measures, and examining theories regarding the relationship between OAB and POP. Relevant original papers and review articles were identified by conducting a literature search using PubMed and Medline. The cause of OAB symptoms and the relationship between vaginal wall prolapse and OAB remain unclear. However, POP repair seems to improve the symptoms of OAB syndrome in 30% to 80% of patients, with a small but significant percentage of patients (≤20%) developing de novo symptoms of OAB.