围绝经期压力性尿失禁女性尿道中段悬吊术后尿路感染危险因素及尿动力学特性

Risk factors for postoperative urinary tract infection in women with perimenopausal stress urinary incontinence undergoing midurethral suspension surgery and characteristics of urodynamics

目的探讨围绝经期压力性尿失禁(SUI)女性尿道中段悬吊术(MUS)后尿路感染危险因素及尿动力学特性。方法选取2019年1月-2021年12月宁波市鄞州第二医院泌尿外科因SUI接受MUS手术患者334例为研究对象,根据术后尿路感染情况将患者分为尿路感染组32例和非尿路感染组302例。收集患者临床资料,采用GBS002型多通道尿动力学检查仪评估患者尿动力学参数腹压漏尿点压、逼尿肌收缩力和残余尿量3项指标。结果两组既往尿路手术史、SUI严重程度和合并糖尿病情况比较差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示既往尿路手术史、SUI严重程度和合并糖尿病均是导致SUI患者MUS术后发生尿路感染的危险因素(P<0.05);尿路感染组腹压漏尿点压和逼尿肌收缩力低于非尿路感染组,而残余尿量水平则反之,差异具有统计学意义(P<0.05);受试者工作特征(ROC)曲线分析结果显示,尿动力学指标腹压漏尿点压、逼尿肌收缩力和残余尿量单指标用于尿路感染预测诊断曲线下面积分别为0.753、0.749、0.772,三指标联合诊断曲线下面积为0.853,预测诊断价值最高。结论既往尿路手术史、SUI严重程度和合并糖尿病均是导致SUI患者MUS术后发生尿路感染的独立危险因素,联合尿动力学指标对于患者尿路感染有一定预测诊断价值。

OBJECTIVE To explore the risk factors for postoperative urinary tract infection in women with perimenopausal stress urinary incontinence(SUI)undergoing midurethral suspension(MUS)surgery and analyze the characteristics of urodynamics.METHODS A total of 334 patients who underwent MUS surgery due to SUI in urology department of Ningbo Yinzhou No.2 Hospital from Jan 2019 to Dec 2021 were recruited as the study subjects and divided into the urinary tract infection group with 32 cases and the non-urinary tract infection group with 302 cases according to the status of postoperative urinary tract infection.The clinical data were collected from the patients.The three urodynamics parameters abdominal leak point pressure,detrusor contractility and residual urine volume were evaluated by GBS002 type multi-channel urodynamic examination instrument.RESULTS There were significant differences in the previous history of urinary tract surgery,severity of SUI and complication with diabetes mellitus between the two groups(P<0.05).The result of multivariate logistic regression analysis showed that the previous history of urinary tract surgery,severity of SUI and complication with diabetes mellitus were the risk factors for postoperative urinary tract infection in the SUI patients undergoing MUS(P<0.05).The abdominal leak point pressure and detrusor contractility of the urinary tract infection group were significantly lower than those of the non-urinary tract infection group,while the residual urine volume level of the urinary tract infection group was significantly higher than that of the non-urinary tract infection group(P<0.05).The result of receiver operating characteristic(ROC)curve analysis showed that the areas under curves(AUCs)of the urodynamics indexes abdominal leak point pressure,detrusor contractility and residual urine volume were respectively 0.753,0.749 and 0.772 in predication and diagnosis of urinary tract infection,while the AUC of the joint detection of the three indexes was 0.853,with the value of prediction and diagnosis the highest.CONCLUSION The previous history of urinary tract surgery,severity of SUI and complication with diabetes mellitus are the independent risk factors for the postoperative urinary tract infection in the SUI patients undergoing MUS,and the joint detection of urodynamics indexes has certain value in prediction and diagnosis of urinary tract infection.