Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction： A Nested Case-control Study

Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.

全盆底重建术后新发压力性尿失禁临床分析

目的通过对盆底重建手术后新发压力性尿失禁(de novo SUI)或SUI加重病例进行回顾性分析,探讨de novo SUI的高危因素。方法回顾性分析2007年1月至2011年2月间因Ⅲ期及以上盆腔器官脱垂(POP)在北京大学人民医院妇科接受Prolift系统全盆底重建术并按时随访的患者140例。根据患者术前、术后SUI的情况将患者分为3组:POP合并SUI组(29例):术前POP合并SUI患者,其中19例行Kelly手术,10例行TVT-O术;de novo SUI组(27例):术前没有尿失禁,术后新发压力性尿失禁患者;对照组(84例):术前、术后均无客观SUI。比较各组POP-Q值及尿动力学参数,logistic回归分析高危因素。结果 ①de novo SUI发生率为24.32%(27/111),其中9例术前合并主观SUI。术前有主观SUI患者术后出现客观SUI的比例是56.25%(9/16),明显高于术前无主观SUI患者(14.88%,18/121;P<0.05);②POP合并SUI组、de novo SUI组的Aa点平均值高于对照组(P<0.01);de novo SUI组的Ba点平均值(4.91)明显高于POP合并SUI组(2.34)和对照组(2.88,P<0.05);③POP合并SUI组的最大尿流率(Qmax)明显高于对照组(P<0.01),de novo SUI组Qmax虽也高于对照组,但差异无统计学意义(P>0.05)。POP合并SUI组和de novo SUI组最大尿道闭合压(MUPP)均显著低于对照组(P<0.01)。④Kelly组中SUI复发率(42.11%,8/19)高于TVT-O组(20.00%,2/10;P<0.05)。⑤logistic回归结果显示,术前主观SUI(P=0.00,OR4.33～7.52),Aa点≥2(P=0.01,OR1.46～1.98),MUPP≤38cmH2O(P=0.00,OR1.73～3.08)为de novo SUI的高危因素。结论①Aa位置低是SUI的高危因素,而当Ba值大即膀胱脱垂明显时,可能掩盖SUI症状,有可能出现术后新发尿失禁;②术前有主观尿失禁症状,MUPP≤38cmH2O是de novo SUI的高危因素;③Kelly术抗尿失禁效果欠佳,建议选择TVT-O术治疗或预防尿失禁。

重度盆腔器官脱垂患者阴道封闭术后新发压力性尿失禁的影响因素

目的:探讨重度盆腔器官脱垂(POP)患者阴道封闭术后新发压力性尿失禁(SUI)的影响因素。方法:选取2017年1月至2021年11月于甘肃省妇幼保健院生殖泌尿科因POPⅢ~Ⅳ度行阴道封闭手术并完成术后随访的104例患者临床资料进行回顾性分析,采用多因素Logistic回归分析术后新发SUI的影响因素。结果:104例患者中,术后新发SUI 22例(21.15%,22/104)(术后新发SUI组)。术后无新发SUI组与术后新发SUI组在高血压病史、术前Aa值、术前尿动力学检查(UDS)膀胱出口梗阻、术前隐匿性尿失禁(OSUI)的比较,差异有统计学意义(P<0.05)。多因素分析显示,重度POP患者阴道封闭术后新发SUI的独立危险因素包括有高血压病史(OR 4.085,95%CI 1.149~14.522,P=0.030)、术前Aa值高(OR 1.933,95%CI 1.159~3.222,P=0.012)、术前UDS膀胱出口梗阻(OR 4.439,95%CI 1.220~16.151,P=0.024)、术前UDS示OSUI(OR 4.565,95%CI 1.304~15.977,P=0.018)。结论:有高血压病史、术前Aa值高、术前UDS膀胱出口梗阻、术前UDS-OSUI是重度POP患者阴道封闭术后新发SUI的独立危险因素。对于有此类高危因素的POP患者,术前综合评估后制定合理的手术方案,必要时术中同时行抗尿失禁手术。

盆腔脏器脱垂术后新发压力性尿失禁风险预测模型的研究进展

术后新发压力性尿失禁是盆腔脏器脱垂(POP)修复术的主要并发症,该并发症的发生易导致患者术后生活质量下降,降低患者对手术治疗的满意度。本文对POP术后新发压力性尿失禁(de novo SUI)风险预测模型的研究展开综述,包括POP术后de novo SUI的概念和危险因素、风险预测模型的概述、国内外研究现状,以及不同风险预测模型的比较分析和研究展望,以期为临床实践和完善术后de novo SUI风险预测模型提供参考。