Combined genitourinary prolapse repair and prophylactic tension-free vaginal tape in women with severe prolapse and occult stress urinary incontinence: Preliminary results

被引:75
作者
Gordon, D [1 ]
Gold, RS [1 ]
Pauzner, D [1 ]
Lessing, JB [1 ]
Groutz, A [1 ]
机构
[1] Tel Aviv Univ, Sackler Fac Med, Tel Aviv Sourasky Med Ctr, Lis Matern Hosp,Dept Obstet & Gynecol,Urogynecol, IL-69978 Tel Aviv, Israel
关键词
D O I
10.1016/S0090-4295(01)01327-9
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives. Continent patients with a positive stress test demonstrated on repositioning of severe genitourinary prolapse are considered to be at high risk of developing postoperative symptomatic stress urinary incontinence (SUI). Our aim was to evaluate in a prospective study whether a prophylactic, tension-free vaginal tape (TVT) procedure, performed during prolapse repair, may prevent the development of postoperative SUI in these women. Methods. Thirty consecutive, clinically continent women (mean age 64.5 +/- 9.04 years) with severe genitourinary prolapse and occult SUI were prospectively enrolled. Occult SUI was defined as a positive stress test with repositioning of the prolapse during the preoperative urodynamic studies. All patients had urethral hypermobility; none had intrinsic sphincter deficiency. In addition to genitourinary prolapse repair, these patients underwent concomitant TVT to prevent postoperative SUI. Patients were followed up for at least 1 year. Repeated urodynamic studies were performed at 3 to 6 months postoperatively. The main outcome measures were postoperative SUI, persistent or de novo detrusor instability, and recurrence of prolapse. Results. The mean duration of follow-up was 14.25 +/- 3.08 months (range 12 to 24). None of the patients developed postoperative symptomatic SUI. However, three asymptomatic patients (10%) had a positive stress test during their postoperative urodynamic evaluation. Nine patients (30%) had detrusor instability before surgery, which persisted in six (66%) postoperatively. Postoperative de novo detrusor instability was diagnosed in four other patients (13.33%). None of the patients had recurrent urogenital prolapse, nor did they have clinical evidence of bladder outlet obstruction. Conclusions. The preliminary results of TVT as a prophylactic procedure in clinically continent women with severe prolapse and occult SUI are encouraging. Long-term follow-up is required to confirm the durability of these results. (C) 2001, Elsevier Science Inc.
引用
收藏
页码:547 / 550
页数:4
相关论文
共 24 条
[1]   STANDARDIZATION OF TERMINOLOGY OF LOWER URINARY-TRACT FUNCTION [J].
ABRAMS, P ;
BLAIVAS, JG ;
STANTON, SL ;
ANDERSEN, JT .
NEUROUROLOGY AND URODYNAMICS, 1988, 7 (05) :403-427
[2]   URODYNAMICS OF FEMALE INCONTINENCE - FACTORS INFLUENCING RESULTS OF SURGERY [J].
ARNOLD, EP ;
WEBSTER, JR ;
LOOSE, H ;
BROWN, ADG ;
WARWICK, RTT ;
WHITESIDE, CG ;
JEQUIER, AM .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1973, 117 (06) :805-813
[3]   CLASSIFICATION OF VAGINAL RELAXATION [J].
BEECHAM, CT .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1980, 136 (07) :957-958
[4]  
BUMP RC, 1988, OBSTET GYNECOL, V72, P291
[5]   Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse [J].
Chaikin, DC ;
Groutz, A ;
Blaivas, JG .
JOURNAL OF UROLOGY, 2000, 163 (02) :531-534
[6]   Surgery for genitourinary prolapse and stress incontinence: A randomized trial of posterior pubourethral ligament plication and Pereyra suspension [J].
Colombo, M ;
Maggioni, A ;
Scalambrino, S ;
Vitobello, D ;
Milani, R .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1997, 176 (02) :337-343
[7]   Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse [J].
Colombo, M ;
Maggioni, A ;
Zanetta, G ;
Vignali, M ;
Milani, R .
OBSTETRICS AND GYNECOLOGY, 1996, 87 (02) :266-271
[8]   Surgical management of pelvic organ prolapse and stress urinary incontinence [J].
Drutz, HP ;
Alnaif, B .
CLINICAL OBSTETRICS AND GYNECOLOGY, 1998, 41 (03) :786-793
[9]   Occult stress urinary incontinence and the effect of vaginal vault prolapse on abdominal leak point pressures [J].
Gallentine, ML ;
Cespedes, RD .
UROLOGY, 2001, 57 (01) :40-44
[10]  
Gordon D, 1999, NEUROUROL URODYNAM, V18, P193, DOI 10.1002/(SICI)1520-6777(1999)18:3<193::AID-NAU5>3.0.CO