術前逼尿肌過動是否能預測經中段尿道吊帶手術之
混合性尿失禁婦女的膀胱過動症變化?
張雲筑1、范玉華1,2,3、林登龍1,2,3
1台北榮民總醫院 泌尿部；2國立陽明大學醫學院 泌尿學科
3書田泌尿科學研究中心
Could detrusor overactivity predict the use of antimuscarinics after
mid-urethral sling in women with mixed urinary incontinence?
Yun-Chu Chang1, Yu-Hua Fan1, 2, 3, Alex T. L. Lin1, 2, 3
1 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
3Shu-Tien Urological Research Center, Taipei, Taiwan
Purpose:
Patients with mixed urinary incontinence (MUI) suffer from components of both stress urinary incontinence (SUI) and overactive bladder (OAB). Many studies have shown that surgical management of SUI with a mid-urethral sling (MUS) may help OAB symptoms. It is important to evaluate the predictive factors of change in OAB symptoms after MUS in MUI patients. We conduct this study to evaluate whether detrusor overactivity (DO) could predict the change in OAB symptoms after MUS in women with MUI.
Materials and Methods:
We retrospectively recruited female patients with MUI treated with retropubic synthetic MUS between 2008 and 2015. All patients completed the questionnaires of Overactive Bladder Symptoms Score (OABSS) and Urogenital Distress Inventory (UDI-6) preoperatively. MUI was defined as clinical SUI with positive response to urgency or urge incontinence subscale of OABSS, or urge incontinence subscale of UDI-6. All patients underwent videourodynamic study prior to MUS. The primary outcome was the postoperative use of antimuscarinics defined as the prescription of antimuscarinics one month after MUS for more than one month. We evaluated the effects of DO and other potential risk factors for the primary outcome.
Results:
A total of 187 patients were included in the study, with 35 demonstrated with DO and 152 without DO. The mean follow-up period after MUS was 15.6 ± 8.7 months. 26 (74.3%) patients with DO and 110 (72.4%) patients without DO required postoperative antimuscarinics. The mean duration of postoperative antimuscarinics was 6.2 ± 4.1 months. There was no significant difference in postoperative antimiscarinics between patients with and without DO. However, patients with lower detrusor pressure at maximum flow tended to use antimuscarinics after MUS in DO patients ( 13.1 ± 7.7 vs 24.9 ± 9.6, p = 0.02 ). Age, body mass index and the combination of pelvic organ prolapse surgery were similar between patients with and without postoperative antimuscarinics. Urgency and urge incontinence subscores of OABSS were significantly higher in patients with postoperative antimuscarinics than those without (2.7 ± 1.6 vs 2.2 ± 1.6, p = 0.04; 2.7 ± 1.4 vs 2.0 ± 1.6, p = 0.01 ) Besides, urgency subscore of UDI-6 was significantly higher in patients requiring postoperative antimuscarinics (2.4 ± 1.3 vs 1.7 ± 1.4, p = 0.01).
Conclusion:
DO alone could not predict the use of antimuscarinics after MUS in women with MUI. Nevertheless, DO patients with lower detrusor pressure at maximum flow have the tendency toward using postoperative antimuscarinics. MUI women with more severe baseline urgency and urge incontinence have higher possibility to use antimuscarinics after MUS.