目的:盆腔器官脱垂(POP)是女性盆底缺损。压力性尿失禁(SUI),急迫性尿失禁(UUI),这些患者可能出现阻塞性症状。手术治疗的目的是恢复盆底的解剖结构和功能;然而,它可能提示以前不存在的泌尿症状。我们进行了系统评价和荟萃分析,以确定接受POP手术矫正的患者的尿动力学变化。
方法:在PubMed和Cochrane数据库中搜索包含POP阴道手术前后尿动力学评估数据的研究。收集的主要尿动力学数据是自由尿流量测定(最大流量[Qmax],作废的音量,和后空隙剩余体积[PVR]),膀胱测压(膀胱容量,存在逼尿肌过度活动[DO],SUI或UUI,和Valsalva泄漏点压力),和压力×流量研究(最大流量时的逼尿肌压力[PdetQmax],Qmax,和PVR)。
结果:共纳入22项研究(1,549名女性)。患者术前DO患病率明显较高(OR=1.56;95%CI=1.06-2.29),没有吊带放置的手术显示出改善DO的趋势。未接受吊带的患者在手术后失禁更多。手术后膀胱排空参数改善,术前PdetQmax较高(IV=3.23;95%CI=0.45-1.18)。未接受MUS的患者在手术前表现出较低的Qmax(IV=-3.19;95CI=-4.09至-2.30)和较高的PVR(IV=27.89;95CI=15.68-40.1)。
结论:POP矫正手术可获得更好的尿动力学排空参数,随着DO患病率的降低。相比之下,吊索的放置增强了阻塞参数。
Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic
review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP.
PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR).
A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06-2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45-1.18). Patients who did not receive MUS presented a lower Qmax (IV = -3.19; 95%CI = -4.09 to -2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68-40.1) before surgery.
Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.