Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling
Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling
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DOI：
10.1097/01.ju.0000063590.13100.4d
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发表时间：
2003-06-01
影响因子：
6.6
通讯作者：
Webster, GD
中科院分区：
文献类型：
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作者：
Miller, EA;Amundsen, CL;Webster, GD
目的：我们确定哪些尿动力学参数可以最好地预测术后排尿功能障碍pubovaginal sling surgery.Materials和Methods：98个连续的妇女谁经历了pubovaginal sling手术与同种异体阔筋膜在1998年7月和2000年7月之间的记录进行了审查。尿动力学和随访数据足以对73例患者进行评价。尿动力学和临床参数与尿潴留，恢复有效排尿的时间和术后尿急症状的发展相关。结果：恢复有效排尿的平均时间为3.92天（中位数3）。在21名无逼尿肌收缩而排尿的女性中，4名（23%）出现尿潴留，而在48名有逼尿肌收缩而排尿的女性中，0名出现尿潴留（p = 0.007）。尿潴留被定义为需要偶尔进行自我导尿。所有4例尿潴留患者的逼尿肌压力均小于12 cm。H2O（0合3，4合1）。所有女性的逼尿肌压力都没有超过12厘米。H2O有尿潴留（p = 0.047）。无逼尿肌收缩的女性中存在Valsalva排尿并不影响尿潴留的发生率（11.1%），与未显示Valsalva排尿的女性（5.1%）相比（p = 0.603）。术前尿动力学峰值流速、逼尿肌不稳定和术后残余尿量与术后尿潴留无关。最后，排尿后残余尿量预测延迟恢复正常排尿（p = 0.001）。有没有其他尿动力学参数与尿潴留，延迟恢复正常排尿或术后尿急症状，包括峰值流速，容量或compliance.Conclusions：女性排尿没有或有一个弱逼尿肌收缩最有可能有尿潴留术后。因此，我们得出结论，术前尿动力学评估可用于咨询妇女的风险，尿潴留后耻骨阴道吊带程序。
Purpose: We determine which urodynamic parameters can best predict postoperative voiding dysfunction following pubovaginal sling surgery.Materials and Methods: The records of 98 consecutive women who had undergone pubovaginal sling surgery with allograft fascia lata between July 1998 and July 2000 were reviewed. Urodynamic and followup data were sufficient for evaluation for 73 patients. Urodynamic and clinical parameters were correlated with urinary retention, time to return of efficient voiding and development of postoperative urgency symptoms.Results: Average time to return of efficient voiding was 3.92 days (median 3). Of 21 women who voided without a detrusor contraction urinary retention developed in 4 (23%) versus 0 of 48 who voided with detrusor contraction (p = 0.007). Urinary retention was defined as the need to perform even occasional self-catheterization. All 4 women with urinary retention had a detrusor pressure of less than 12 cm. H2O (0 in 3, 4 in 1). None of the women with a detrusor pressure of greater than 12 cm. H2O had urinary retention (p = 0.047). The presence of Valsalva voiding in women without a detrusor contraction did not affect the incidence of urinary retention (11.1%) compared to those who did not demonstrate Valsalva voiding (5.1%) (p = 0.603). Peak flow rate, detrusor instability on preoperative urodynamics and post-void residual urine volume were not associated with postoperative urinary retention. Finally, post-void residual urine volume predicted delayed return to normal voiding (p = 0.001). There were no other urodynamic parameters that were significantly associated with urinary retention, delayed return to normal voiding or postoperative urgency symptoms including peak flow rate, capacity or compliance.Conclusions: Women who void without or with a weak detrusor contraction are most likely to have urinary retention postoperatively. Therefore, we conclude that preoperative urodynamic evaluation may be used to counsel women regarding the risk of urinary retention following the pubovaginal sling procedure.