Efficacy And Safety Analysis Of The Implant Substitute’s Pelvic Surgery For Pelvic Floor Dysfunction In Elderly Female Patients

Objective: To investigate the efficacy and safety of the implant substitute’s pelvicsurgery for pelvic floor dysfunction in older women with pelvic floor dysfunction.Methods：Clinical data were collected from January2007~January20l3in NanjingGeneral Hospital of Fuzhou military command from women with pelvic floordysfunction patients, and establish a case-control according to the age of patients,retrospective analysis.The first part:189patients with pelvic organ prolapse according to age is olderthan65years of aging group (n=93) and control group (n=96): a case-control.Comparative analysis between the two groups in age, gravidity, parity, course ofdisease, BMI, menopausal status, combined disease, pelvic floor prolapse operationhistory, etc. these demographic data; volume, operation time, operation mode,combined with operation, anesthesia complications, intraoperative peri operationperiod of intraoperative bleeding and postoperative hospital stay; and the indwellingcatheter time, hospitalization, and postoperative complications. And POP-Q was usedto evaluate two patients objective cure, evaluation of its quality and life improvementof subjective quality of life of PFIQ-7, PFDI-20and PISQ-12questionnaire.The second part:217patients with urinary incontinence patients according to ageis more than65years were divided into aged group (n=76) and control group (n=141):a case-control analysis, comparison between the two groups in age, gravidity, parity,course of disease, BMI, menopausal status, combined disease, history of pelvicoperation, VLPP, urine incontinence severity and pad test and other demographic data;intraoperative bleeding volume, operation time, operation mode, anesthesiacomplications, intraoperative per-operation period; postoperative hospital stay andindwelling catheter time, hospitalization; postoperative complications and theobjective cure. And the application of IIQ-7, UDI-6, I-QOL and PISQ-12 questionnaire to evaluate the subjective quality of life.Result：The first part:1、The two groups in age, parity, body mass index (BMI), the difference wasstatistically significant disease, menopausal period, combined with disease (P<0.05),aged group are relatively higher, and in the history of pelvic operation, pelvic organprolapse indexing and cervical extension have statistically significant differences withcontrol group (P>0.05).2、During the operation and hospitalization: aged group and the control group inthe amount of bleeding was123.72±55.07ml,139.79±66.49ml; indwelling cathetertime was3.30±1.52,3.16±0.91days; postoperative hospital stay was5.40±1.71days,5.15±0.87days; the operation mode, anesthesia,combined with operation，intraoperative complications no significant differences (P>0.05). The averageoperation time of two groups were88.54±23.29min,80.62±9.74min, aged groups ofpatients with operation time is longer, the difference was statistically significant (P<0.05);3、Objective: the objective cure compared POP-Q to TVL (the total length of thevagina) in the preoperative, postoperative comparison, aged group were7.2±0.7cm,7.6±0.4cm, the control group were7.3±0.7cm,7.5±0.8cm, except for TVLcompared with the preoperative not change significantly, the other points are obviousimproved (P <0.05) respectively; and on the two groups of patients with POP-Q in thepreoperative, postoperative comparison can be seen, aged group in postoperativeanatomical reduction and control group had no significant difference (P>0.05).4、subjective cure comparison:(1) aged group before and after the operation, the total score of PFIQ-7were76.08±13.86,41.56±7.85; the total score of PFDI-20were80.58±15.74,43.04±7.28, the total score of PISQ-12was12.34±2.36,18.56±3.87;(2) The control group before and after operation, the total score of PFIQ-7inwere78.06±10.50,44.87±10.11; the total score of PFDI-20scores were75.77± 11.46,41.24±8.44, the total score of PISQ-12was13.46±3.89,22.50±4.96;(3) each group after operation, the total score of PFIQ-7and PFDI-20weresignificantly lower than that before operation, showed significant improvement inquality of life, the total score of PISQ-12was significantly higher than that beforeoperation, quality of sexual life were markedly improved; two groups of patientsbefore surgery, preoperative quality of life and life quality had no significantdifferences. After the operation, but the aging group compared with control group, thequality of sexual life of patients with poor in aged group.5、Comparison of postoperative complications: two groups of patients havesome complications, mainly has the Mesh exposure, new-onset urinary incontinence,lower urinary tract symptoms, thigh and buttock pain, recurrent prolapse, aging groupwere7.5%,3.2%,4.3%,3.2%,2.2%, the control group was2.1%,2.1%,2.1%,2.1%,1%, two groups of patients with postoperative complication rates were not statisticallysignificant (P>0.05).The second part:1、The two groups in age, gravidity, course of disease, menopausal period, withdifferent diseases, history of pelvic operation, pad test on a statistical difference (P<0.05), and the body mass index (BMI), no significant differences in urinaryincontinence types.2、During the operation and hospitalization: postoperative hospital stay, indwellingcatheter time and the incidence of intraoperative complications, aging group were2.24±1.12days,1.17±0.86days,1.3%, the control group was2.11±0.53days,1.07±0.35days,0.7%, with no significant difference between two groups (P>0.05). Butrelative to the control group, the amount of bleeding in aged group (aged group was29.66±24.72ml，control group was41.58±42.62ml), long operation time (aginggroup was22.78±9.92ml，the control group was29.87±12.33ml), with more basicanesthesia operation widely used, the difference has statistical significance (P <0.05);3、Aging group cure rate, improvement rate, no efficiency were92.1%,6.6%,1.3%, control group were92.9%,7.1%,0%. No statistically significant difference between groups (P>0.05);4、subjective cure comparison:(1) patients aged before and after the operation, the total score of IIQ-7were11.35±2.39,9.27±2.12; the total score of UDI-6were8.70±1.01,6.08±0.93; thetotal score of I-QOL scores were50.84±8.34,73.46±9.25; the total score ofPISQ-12scores were11.53±2.07,16.86±2.61.(2) patients in the control group before and after operation, the total score ofIIQ-7were11.09±2.81,9.09±2.60; the total score of UDI-6were8.71±0.89,6.83±0.86; the total score of I-QOL scores were53.76±7.56,74.46±9.86; the total scoreof PISQ-12scores were13.30±3.34,22.09±5.05.(3) the two groups of patients with IIQ-7, UDI-6score were decreased, I-QOLand PISQ-12score were significantly higher, there was statistically significantdifference relative before operation (P<0.05), suggesting that the two groups ofpatients with postoperative quality of life and quality of sexual life were significantl yimproved; but the aging before surgery, postoperative,the total score of PISQ-12thanthe control group, suggesting the sexual life quality of patients with aged grouprelatively poor.5、Comparison of postoperative complications: two groups of patients have somecomplications, mainly micturition posture change, new OAB, thigh pain, recurrence,aging group were9.21%,2.63%,2.63%,1.32%; the control group were0.71%,1.42%,1.42%,0.71%. Among the aging group complications are relatively more seen, but thecomplication rates were not statistically significant (P>0.05).Conclusion:1、 the efficacy and safety of the implant substitute’s pelvic surgery for pelvicfloor dysfunction in female pelvic floor dysfunction are exact, aging of the influence isnot obvious;2、The implant substitute’s pelvic surgery for pelvic floor dysfunction cansignificantly improve the life quality of patients;3、The aging may be a risk factor for increased the intraoperative, postoperative complications of implant substitute’s pelvic surgery for pelvic floor dysfunction infemale pelvic floor dysfunction.