Levator trauma is associated with pelvic organ prolapse
Levator trauma is associated with pelvic organ prolapse
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DOI：
10.1111/j.1471-0528.2008.01751.x
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发表时间：
2008-07-01
影响因子：
5.8
通讯作者：
Simpson, J. M.
中科院分区：
文献类型：
--
作者：
Dietz, H. P.;Simpson, J. M.
目的评估泌尿妇科门诊人群中与上睑提肌撕脱伤相关的脱垂风险。设计回顾性观察研究。设置三级泌尿妇科单位。样本共934名女性接受采访，使用盆腔器官脱垂量化（POP-Q）分期系统进行检查，并通过四个-三维经唇超声。方法回顾性分析图表和存储的成像数据。主要结果测量盆腔器官脱垂II期及以上和存在的缺陷提肛肌。结果排除137名妇女的病史后，抗尿失禁或脱垂手术，并进一步排除了16名妇女，其中无论是检查或成像是不可能的，我们比较了781名妇女的脱垂和成像数据。平均年龄为53岁（范围15-89岁），中位产次为2次（范围0-12）。女性报告压力性尿失禁（76%）、急迫性尿失禁（69%）、尿频（47%）、尿失禁（49%）和脱垂症状（38%）。415名（53%）女性被诊断为严重脱垂（II期或更高），181名（23%）女性被发现有提上睑撕脱缺损。在150/181（83%）例撕脱女性和265/600（44%）例无撕脱女性中观察到脱垂，相对风险（RR）为1.9（95%CI 1.7-2.1）。膀胱膨出（RR 2.3，95%CI 2.0-2.7）和子宫脱垂（RR 4.0，95%CI 2.5-6.5）的相关性最强。这种影响主要是由于膀胱膨出和子宫脱垂的风险增加。
Objective To estimate the risk of prolapse associated with levator avulsion injury among a urogynaecological clinic population.Design Retrospective observational study.Setting Tertiary urogynaecological unit.Sample A total of 934 women seen for interview, examination using the pelvic organ prolapse quantification (POP-Q) staging system and imaging of the levator ani muscle by four-dimensional translabial ultrasound.Methods Retrospective review of charts and stored imaging data.Main outcome measures Pelvic organ prolapse stage II and higher and presence of defects of the levator ani muscle.Results After exclusion of 137 women with a history of anti-incontinence or prolapse surgery, and a further exclusion of 16 women in whom either examination or imaging was impossible, we compared prolapse and imaging data in 781 women. Mean age was 53 years (range 15-89 years), and median parity was 2 (range 0-12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (stage II or higher) was diagnosed in 415 (53%) women, and 181 (23%) women were found to have levator avulsion defects. Prolapse was seen in 150/181 (83%) women with avulsion and in 265/600 (44%) women without avulsion, giving a relative risk (RR) of 1.9 (95% CI 1.7-2.1). The association was strongest for cystocele (RR 2.3, 95% CI 2.0-2.7) and uterine prolapse (RR 4.0, 95% CI 2.5-6.5).Conclusions Women with levator avulsion defects were about twice as likely to show pelvic organ prolapse of stage II or higher than those without. This effect is mainly due to an increased risk of cystocele and uterine prolapse.