Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence

The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI.

A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples.

A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2= 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2= 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2= 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05).

No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.

全盆底重建术前后尿失禁发生和治疗的研究 摘要 背景: 盆底重建术同时行抗尿失禁手术用于预防盆腔器官脱垂患者术后尿失禁仍然存在争议。本文研究目的是描述盆底重建术前、术后尿失禁发生的情况,以及评估盆腔器官脱垂合并尿失禁的处理。方法:2009年6月至2015年2月我院共计329名患者行全盆底重建术纳入研究。这些患者分成两组:A组行Prolift重建术,190人;B组行改良全盆底重建术,139人。记录患者的手术方式及一般资料。卡方检验、t检验用于两个独立样本分析。结果:术前共有115人患尿失禁。平均随访时间46.5月,20名(6.1%)患者失访。压力性尿失禁、急迫性尿失禁及混合性尿失禁的治愈率分别是51%(30/59)、80%(16/20)及48%(14/29)。盆底重建术后急迫性尿失禁的治愈率(80%, 16/20) 高于压力性尿失禁(50.8%, 30/59;P= 0.035),而混合性尿失禁的治愈率最低(48%, 14/29)。术后有尿失禁症状患者的治愈率低于术前有症状的患者(9.1% [28/309] vs. 16.2% [50/309],P= 0.007)。术后尿失禁的发生率在两组间没有明显差异(P>0.05)。TVT-O治疗压力性尿失禁与未行TVT-O之间没有明显差异 (42.9% [6/14] vs. 53.3% [24/45];P= 0.493)。两种盆底重建术在治疗盆腔器官脱垂合并/不合并尿失禁没有明显差异 (P>0.05)。结论:尿失禁的发生和盆底手术没有明确关系。抗尿失禁治疗应在盆底重建术后再进行。.

Chinese medical journal. 2018 Mar 05 [Epub]

Yu Song, Xiao-Juan Wang, Yi-Song Chen, Ke-Qin Hua

Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China., Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.