| Background and purpose:Pelvic floor dysfunction(PFD)is due to various causes of pelvic floor support system such as the weak of pelvic floor muscle and fascia,and a series of abnormal pelvic organ function and anatomical cause of pelvic organ prolapse(POP),stress urinary incontinence(SUI),fecal incontinence(FI),postpartum sexual dysfunction etc.All are included.Among with them,Pelvic organ prolapse,female stress urinary incontinence and genital tract injury are common problems.About 30%-50% of women at some point in their lives,following uterine,vaginal prolapse of the anterior and posterior walls [1-2].With the aging of the population,its incidence is gradually increasing,which seriously affects the physical and mental health of the patients.In addition to the promotion of modern women's health awareness and the pursuit of quality of life,more and more POP patients require active treatment.At present,two or more pelvic organ prolaps emainly through the pelvic floor reconstruction surgery for treatment,the concept is reasonable to use alternative repair,reconstruction of structural strength,and advocate the overall reconstruction.So as to achieve satisfactory long-term efficacy.SUI and POP exist often at the same time,and some patients before operation can not determine whether the merger exists,so the surgeon in the pelvic floor reconstruction surgery at the same time whether the implementation of anti-urinary incontinence surgery requires adequate preoperative assessment and consideration.At present,there are many ways to treat POP patients,including: vaginal hysterectomy,sacrospinous ligament fixation(SSF),the anterior and posterior vaginal wall repair,pelvic floor reconstruction surgery,laparoscopic sacral colpopexy,laparoscopic uterine sacral fixation.According to the relevant literature [3-5],POP patients after the pelvic floor reconstruction are easy to cause the new stress urinary incontinence,a variety of surgery are involved,and which occult stress urinary incontinence(Occult stress urinary incontinence,OSUI)is one of the important causes of de novo stress urinary incontinence(de novo SUI).the incidence of stress urinary incontinence was 26.3% to 44.1% after repair of POP patients with OSUI.For patients with no urinary incontinence subjective symptoms and diagnostic basis before pelvic floor reconstruction,but there comes postoperative pressure urinary incontinence,called postoperative de novo SUI [6].For this part of the patients,there are a small number of literature [7-8] reported the occurrence of the relevant factors,considering whether anti-urinary incontinence surgery requires at the same time is also the focus of the study and difficult.This paper aims to retrospectively analyze the patients with pelvic floor function reconstruction in our hospital for nearly 10 years,and to study the related factors of de novo stress urinary incontinence after the pelvic floor reconstruction and provide a theoretical and practical basis for the effective treatment of patients with POP.MethodsFrom November 30,2005 to November 30,2015 a total of 714 POP patients in theFirst Affiliated Hospital of Third Military Medical University underwent pelvic floor reconstruction surgery in obstetrics and Gynecology,the preoperative diagnosis of no urinary incontinence in patients with a total of 544 cases of patients,according to subjective clinical symptoms,physical examinations and partial implementation of urodynamic examination have eliminated urge urinary incontinence,stress urinary incontinence and urinary patients,which has been performed urinary incontinence surgery.It is reported that there is no evidence of urinary incontinence before operation,but there are subjective symptoms of urinary incontinence or the presence of objective signs of urinary incontinence,which can be diagnosed as de novo stress urinary incontinence [9].The study of outpatient follow-up on postoperative patients by more than in June,(1)clinical subjective symptoms(2)objective physical examination(3)the international consultation on incontinence questionnaire short form(ICI-Q-SF)[10]and the Incontinence Impact Questionnaire short form(IIQ-7)[11](4)urodynamic examination.Diagnosing Patients with de novo stress urinary incontinence after the pelvic floor reconstruction.The follow up period was over in June 12,2016.A total of 495 cases were followed up successfully.According to whether or not the de novo stress urinary incontinence,divided into the incidence group and non disease group,the clinical data were statistically analyzed,and compared the differences between the two groups.And analyze the relevant influencing factorsResults1.POP patients with pelvic floor reconstruction surgery,151 cases of de novo stress urinary incontinence,the incidence was 30.5%.(1)In the cough,laughing,sneezing and increased abdominal pressure can cause urine leakage and the clinical symptoms were obvious in 50 cases,accounting for 33.1%(2)Clinical subjective symptoms were obvious,but physical examination objective signs were not obvious,and completed the questionnaire scale in 86 cases,accounting for 56.9%(3)there is doubt and can not identify the diagnosis,through the urodynamic diagnosis of 15 cases,accounting for 10%.2.The history of fetal macrosomia is the most important risk factor for postoperative urinary incontinence(OR 5.286 95%CI 1.74~16.001);The history of diabetes and the history of pelvic surgery are also risk factors for postoperative stress urinary incontinence(OR 2.575 95%CI1.404~ 4.720 OR 1.671 95%CI1.095~2.550).3.Among pelvic floor reconstruction surgery,to laparoscopic sacral colpopexy(OR 1)as a reference,the other three were compared with it,anterior pelvic floor reconstruction(OR 0.269 95%CI0.131~0.549),vaginal hysterectomy and sacrospinous ligament suspension(OR 0.35495% CI0.191~0.657),laparoscopic uterine sacral fixation(OR 0.435 95%CI 0.221~0.855),the above three surgical methods are OR <1.Reverse description of it,comparing the laparoscopic sacral colpopexy with the other three surgical methods,which is more prone to cause de novo stress urinary incontinence.4.Age,pregnancy,birth,history of hypertension,history of smoking,history of constipation,history of chronic bronchitis,history of estrogen therapy,whether menopause,vaginal delivery,uterine prolapse,vaginal anterior wall prolapse,vagina Wall swelling is not a postoperative risk factor for de novo stress incontinence.ConclusionResearch shows that fetal macrosomia delivery history,history of pelvic surgery,a history of diabetes and laparoscopic sacral colpopexy are risk factors for de novo s tress urinary incontinence.POP patients with fetal macrosomia delivery history,laparoscopic sacral colpopexy,history of pelvic surgery and a history of diabetes,in pelvic floor reconstruction surgery,can be possible to result in the de novo stress urinary incontinence.with the above risk factors of the patients can take active preventive measures,according to the situation of individual patients and willingness to consider and implement of anti incontinence surgery at the same time. |
PDF Full Text Request