术前尿动力学检查对盆腔脏器脱垂患者术后尿失禁的预测价值

The Predictive Value of Preoperative Urodynamics for Stress Urinary Incontinence Following Prolapse Surgery

目的:探讨术前尿动力学检查(UDS)对术后新发压力性尿失禁(de novo SUI)的阴性预测价值。方法:对北京大学人民医院妇科2014年1月至2016年12月因盆腔脏器脱垂住院并手术、术前行UDS的177例患者进行回顾性研究。结果:177例患者,UDS对de novo SUI的阴性预测值(NPV)为89.9%;UDS无SUI的138例患者中,术前无SUI症状者83例,术中未行抗SUI手术,10例患者术后发生了de novo SUI,其中1例需手术治疗,做了抗SUI手术,再手术率1.2%(1/83)。98例行经阴道网片置入的盆底重建术(TVM),UDS对这部分患者de novo SUI的NPV 89.6%;UDS无SUI,但有SUI症状患者36例,19例术中同时行尿道中段悬吊术手术,17例未做,前者de novo SUI发生率10.5%,后者无de novo SUI发生。结论:术前UDS对de novo SUI有较高的阴性预测价值,对术前有SUI症状的患者,UDS也可作为协助决定是否同时抗尿失禁手术的方法。

Objective:To investigate the negative predictive value(NPV)of preoperative urodynamic examination(UDS)for de novo stress urinary incontinence(de novo SUI).Methods:A retrospective study was performed on 177 patients admitted to Peking University People's Hospital from January 2014 to December 2016 for pelvic organ prolapse who underwent UDS before surgery.Results:The NPV of UDS to de novo SUI was 89.9%in 177 patients.Among the 138 patients without SUI in UDS,83 patients had no preoperative SUI complaint,and 10 patients developed de novo SUI after operation,of which 1 patient needed anti-SUI operation,and the reoperation rate was 1.2%(1/83).98 patients underwent pelvic floor reconstruction with transvaginal mesh,and UDS showed 89.6%of NPV in these patients.There were 36 patients with preoperative SUI complaint but no demonstrate SUI in UDS.19 patients received mid-urethral sling(MUS)during surgery,while other 17 did not.The incidence of de novo SUI in the MUS group was 10.5%,while that in the other group was none(P>0.05).Conclusions:Preoperative UDS has a high negative predictive value for de novo SUI.For patients with preoperative SUI symptoms,UDS can also be used as a method to decide whether to perform MUS simultaneously.