围绝经期和绝经后妇女盆腔脏器脱垂相关压力性尿失禁的尿动力学研究

Pelvic Organ Prolapse Associated With Stress Urinary Incontinence in Perimenopausal and Postmenopausal Women With Urodynamic Study.

目的了解围绝经期和绝经后妇女盆腔脏器脱垂(pelvic organ prolapse,POP)患者临床相关的压力性尿失禁的尿动力学特点,分析盆腔脏器脱垂和压力性尿失禁(stress urinary incontinence,SUI)的关系。方法研究对象为2003年1月至2006年12月因盆腔脏器脱垂或压力性尿失禁在本院住院手术的108例经产妇。对98例进行临床尿动力学检查,包括腹压漏尿点压(ALPP)、静止性尿道压力(UPP)测定[功能性尿道长度(FUL)、最大尿道压(MUP)、最大尿道关闭压(MUCP)]。盆腔脏器脱垂诊断分期,按国际尿控制协会盆腔器官脱垂分期(POP-Q)进行(分组征得患者知情同意)。结果盆腔脏器脱垂患者中,临床诊断的压力性尿失禁占68.5%(74/108)。完成尿动力学检查的盆腔脏器脱垂患者的腹压漏尿点压测出率高达71.4%(70/98)。SUI组(n=70)患者的腹压漏尿点压测出率为87.1%(61/70)。其中,腹压漏尿点压<90 cm H2O为56.1%(55/98),≤60 cm H2O为26.5%(26/98)。非SUI组患者中,腹压漏尿点压呈阳性的患者为32.1%(9/28)。腹压漏尿点压均数比较,SUI组明显低于非SUI组(P<0.001)。以腹压漏尿点压测定为标准,盆腔脏器脱垂患者的隐性压力性尿失禁可能性为9.2%(9/98)。SUI组与非SUI组患者的尿动力学检测结果比较,功能性尿道长度、最大尿道压、最大尿道关闭压值,差异无显著意义(P>0.05)。结论无压力性尿失禁的盆腔脏器脱垂患者与压力性尿失禁患者功能性尿道长度、最大尿道关闭压比较,差异无显著意义。建议在盆腔脏器脱垂矫治术中,对无压力性尿失禁症状,且功能性尿道长度变短、最大尿道关闭压、最大尿道压低者,行预防性压力性尿失禁矫治术。

Objective To explore the clinical and urodynamic features of pelvic organ prolapse （POP） and its relationship with stress urinary incontinence （SUI）. Methods From January 2003 to December 2006, 108 cases of perimenopausal and postmenopausal women, hospitalized in the Department of Obstetrics and Gynecology, GongLi Hospital, were admitted with stress urinary incontinence or pelvic organ prolapse surgeries, who had the urodynamic test aimed to evaluate prolapse based on the pelvic organ prolapse quantification （POP-Q） system, including the test of abdominal leak point pressure （ALPP）, functional urethral length （FUL）, maximal urethral closure pressure （MUCP）, and maximal urethral pressure （MUP）. Informed consent was obtained from all the participates. Results Among pelvic organ prolapse patients, stress urinary incontinence cases accounted for 68.5% （74/108）. In terms of abdominal leak point pressure, the positive rate was 71.4%（70/98） in the pelvic organ prolapse patients who had participated in the urodynamic test. For functional urethral length, maximal urethral pressure, and maximal urethral closure pressure, significant decrease was identified in patients with pelvic organ prolapse. As to the abdominal leak point pressure among patients with and without stress urinary incontinence, the positive rates were 87. 1 % and 32. 1%, respectively. In patients with uterine prolapse, the abdominal leak point pressure significantly increased over others. Taken of pressures at the abdominal leak point to evaluate, the incidence of occult stress urinary incontinence in pelvic organ prolapse patients would be 9. 2% （9/98）. There was no statistical difference in functional urethral length, maximal urethral pressure, and maximal urethral closure pressure between patients with stress urinary incontinence or not（P〉0.05）. Conclusion It is necessary to carry out preventive stress urinary incontinence correction operation for pelvic organ prolapse patients without clinical symptoms of stress urinary incontinence, in the condition of shorter functional urethral length, low maximal urethral closure pressure, and maximal urethral pressure value.