Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & M...Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.展开更多
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 ur...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.展开更多
目的 分析老年子宫脱垂患者术后新发压力性尿失禁(de novo SUI)情况及其影响因素。方法 回顾性分析泗县人民医院2020年10月~2023年5月期间因子宫脱垂行手术治疗的60例患者,调查患者术后de novo SUI发生情况,将患者分为无de novo SUI组及...目的 分析老年子宫脱垂患者术后新发压力性尿失禁(de novo SUI)情况及其影响因素。方法 回顾性分析泗县人民医院2020年10月~2023年5月期间因子宫脱垂行手术治疗的60例患者,调查患者术后de novo SUI发生情况,将患者分为无de novo SUI组及de novo SUI组,通过单因素及多因素logistic回归分析影响患者术后de novo SUI发生的相关因素。结果 60例行手术治疗的子宫脱垂患者,18例患者术后发生de novo SUI,发病率为30.00%。单因素分析结果显示,体质量指数(BMI)、高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史、雌激素治疗史是影响老年子宫脱垂患者术后de novo SUI的相关因素(χ^(2)=5.701、4.775、6.782、4.113、3.951、5.644、9.966,P<0.05)。多因素logistic分析结果显示,高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史为老年子宫脱垂患者术后de novo SUI的独立危险因素(P<0.05)。结论 老年子宫脱垂患者术后存在一定的de novo SUI发生风险,高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史为老年子宫脱垂患者术后de novo SUI的独立危险因素。展开更多
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...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。展开更多
文摘Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.
文摘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.
文摘目的 分析老年子宫脱垂患者术后新发压力性尿失禁(de novo SUI)情况及其影响因素。方法 回顾性分析泗县人民医院2020年10月~2023年5月期间因子宫脱垂行手术治疗的60例患者,调查患者术后de novo SUI发生情况,将患者分为无de novo SUI组及de novo SUI组,通过单因素及多因素logistic回归分析影响患者术后de novo SUI发生的相关因素。结果 60例行手术治疗的子宫脱垂患者,18例患者术后发生de novo SUI,发病率为30.00%。单因素分析结果显示,体质量指数(BMI)、高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史、雌激素治疗史是影响老年子宫脱垂患者术后de novo SUI的相关因素(χ^(2)=5.701、4.775、6.782、4.113、3.951、5.644、9.966,P<0.05)。多因素logistic分析结果显示,高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史为老年子宫脱垂患者术后de novo SUI的独立危险因素(P<0.05)。结论 老年子宫脱垂患者术后存在一定的de novo SUI发生风险,高血压史、巨大儿分娩史、糖尿病史、便秘史、盆腔手术史为老年子宫脱垂患者术后de novo SUI的独立危险因素。
文摘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。
