摘要目的 探讨阴道前壁脱垂患者手术前尿动力学检查与患者术前膀胱过度活动症(OAB)症状及盆底修复手术后持续存在的OAB症状的相关性.方法 从2010年1月1日至2012年10月31日,在北京大学人民医院选择175例阴道前壁脱垂≥Ⅲ度患者术前行尿动力学检查,将术前尿动力学检查结果与患者手术前后合并存在的OAB症状进行分析.结果 (1)盆底修复手术后12 ～ 24个月,OAB症状中的尿频改善了71.0％(71/100),尿急并漏尿改善了69.2％(63/91).(2)术前尿动力学检查:排尿初急迫感＜100 ml的比率为6.3％(11/175),有逼尿肌过度活动者14.9％(26/175),残余尿量≥50 ml为11.4％(20/175),最大尿流率(Qmax)为(16±7) ml/s.(3)术前诊断OAB与无OAB症状患者的尿动力学检查结果比较显示,术前诊断OAB的患者中Ⅲ型压力性尿失禁的比率[5％(5/91)]较无OAB症状者[0(0/84)]高,两者比较,差异有统计学意义(P=0.022).(4)术前有OAB症状的患者中,术后尿急并漏尿症状改善者的Qmax[(17±7) ml/s]明显高于未改善者[(13±5)ml/s],两者比较,差异有统计学意义(P＜0.01).结论 盆底修复手术可明显缓解阴道前壁重度脱垂患者的OAB症状,但术后持续存在的尿频、尿急并漏尿症状,目前尚无确切的预测指标,持续存在尿急并漏尿可能与术前尿动力学检查Qmax有关.

abstractsObjective To identify pre-operative demographic and urodynamic (UD) parameters related to overactive bladder (OAB) symptoms of pre-operation and persistence of after pelvic organ prolapse (POP) repair.Methods From Jan 1,2010 to Oct 31,2012,this perspective study examined demographic and UD data of 175 patients undergoing POP surgery.Pre-and post-operative urinary distress inventory 6 (UDI-6) scores for frequency and urge urinary incontinence (UUI) were analyzed,and correlations between scores and pre-operative UD data were also analyzed.Results (1)Surgery resulted in a improvement of frequency (71.0％,71/100) and UUI (69.2％,63/91) at 12-24 months follow-up.(2)Pre-operative UD parameters:first desire of bladder ＜100 ml,6.3％ (11/175); detrusor overactivity,14.9％ (26/175); post-void residual ≥50 ml,11.4％ (20/175); maximal flow rate (Qmax),(16±7) ml/s.(3)Comparison of pre-operative UD datas between patients with OAB symptoms and without,with OAB symptoms group had more patients of type Ⅲ stress urinary incontinence [5％ (5/91) versus 0 (0/84),P=0.022].(4)Qmax was higher in improvement in UUI group than that in persistent UUI after POP repair [(17±7) m]/s versus (13±5) ml/s,P＜0.01].Conclusions POP repair significantly reduces OAB symptoms; however,there had not exact predictor for symptoms of persistent frequency,UUI after POP repair.Persistent UUI symptom may be related to Qmax of pre-operative UD.