背景:本章建议中涉及的问题是:对生殖器脱垂的女性进行临床和临床评估,并已决定对其进行手术治疗。必须考虑哪些检查的临床要素作为手术后失败或复发的风险因素,为了预测和评估可能的手术困难,并朝着首选的手术技术迈进?
方法:这项工作基于对文献的系统回顾(PubMed,Medline,科克伦图书馆,Cochrane系统评价数据库,EMBASE)用于元分析,随机试验,登记册,文献综述,对照研究和主要非对照研究,发表在主题上。它的实施遵循了HAS关于临床实践建议的方法,用科学的论证(用证据的水平,NP)和推荐等级(A,B,C,和专业协议[AP])。
结果:首先要描述脱垂,通过临床检查,帮助,如果需要,如果临床检查数据不足或发现功能体征与临床异常之间存在差异,则通过图像的补充,或在相关病理学有疑问的情况下。适合查看复发危险因素(高度脱垂)和术后并发症危险因素(假体暴露的危险因素,手术方法困难,具有超敏反应的盆腔疼痛综合征)以告知患者并指导治疗选择。与脱垂(尿失禁,膀胱过度活动症,排尿困难,尿路感染,上尿路影响)将通过访谈和临床检查以及测量排尿后残留物的流量计进行搜索和评估,尿液分析,和肾脏膀胱超声检查.在存在排尿障碍的情况下,对其进行临床和尿动力学评估是合适的。在没有任何自发或隐藏的尿征的情况下,到目前为止,没有理由建议进行系统的尿动力学评估。与脱垂相关的肛门直肠症状(肠易激综合征,排便阻塞,大便失禁)应进行搜索和评估。脱垂手术前,重要的是不要忽视妇科病理。
结论:在提出手术治疗女性生殖器脱垂之前,它适合于实现临床和临床旁评估来描述脱垂(涉及的解剖结构,grade),寻找复发,困难的方法和术后并发症的危险因素,并了解与脱垂相关的影响或症状(泌尿,肛门直肠,妇科,盆腔-会阴疼痛)以指导他们的评估和治疗。©2016由ElsevierMassonSAS发布。
BACKGROUND: The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique?
METHODS: This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]).
RESULTS: It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology.
CONCLUSIONS: Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.