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

• Published in: Chinese medical journal Vol. 131; no. 5; pp. 553 - 558
• Main Authors: Song, Yu, Wang, Xiao-Juan, Chen, Yi-Song, Hua, Ke-Qin
• Format: Journal Article
• Language: English
• Published: China Wolters Kluwer India Pvt. Ltd 05.03.2018; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China%Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Aged; Care and treatment; Complications and side effects; Family medical history; Female; Gynecology; Hospitals; Humans; Laboratories; Male; Middle Aged; Obstetrics; Original; Patients; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Pelvic Organ Prolapse; Recurrence; Urinary Incontinence; Plastic surgery; Postoperative Period; Retrospective Studies; Risk factors; Statistical analysis; Suburethral Slings; Systematic review; Treatment Outcome; Urinary incontinence; Urinary Incontinence - surgery; Urine; Urology; Uterine prolapse; Womens health; 骨盆;管理;机关;外科手术;流行音乐;尿;痊愈率;人口统计; China; United States > US; Recurrence; Urinary Incontinence; Pelvic Organ Prolapse
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.226057

Background： 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 U1. Methods： 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. Results： A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to tbllow-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 MUl （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 Ul postoperatively between Groups A and B （P 〉 0.05）. The cure rate of SUl in patients undergoing tension-free vaginal tape-ohturator 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 U1 between these two types of reconstructions （P 〉 0.05）. Conclusions： 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.