| Background Pelvic organ prolapse(POP)is a common disease in the elderly female group.At present,there is no standard for the treatment of pelvic organ prolapse,and for patients who have failed or refused non-surgical treatment,surgical procedures are the last method to improve their symptoms and return to normal life.Surgery can improve symptoms and restore the anatomy of pelvic floor in a short period of time,but some patients have not been able to usher in a normal life after surgery:the anatomy returns to normal,symptoms of urinary incontinence emerge.Urinary incontinence and pelvic organ prolapse are both pelvic floor dysfunction diseases,and are also common diseases in middle-aged and elderly women,mainly including stress urinary incontinence,urgent urinary incontinence,and mixed urinary incontinence.However,no matter which kind of urinary incontinence,it will undoubtedly bring great harm to the patient’s work,social interaction,and physical and mental health.Objective To explore the risk factors of de novo urinary incontinence after surgery in order to help physicians evaluate the treatment and provide patients with adequate preoperative and postoperative consultation,so as to truly improve the quality of life of patients with pelvic organ prolapse.Methods The first part:A computerized search of CNKI,Wanfang electronic database,Chinese medical biology literature,PubMed,Embase database,and Cochrane Library was conducted to collect case-control studies and cohort studies related to new-onset urinary incontinence after pelvic organ prolapse at home and abroad,with the search period from 2000 to 2021.The Chinese key terms "pelvic organ prolapse","urinary incontinence" and"postoperative period" were used,and "Pelvic organ Prolapse","Urinary Incontinence",and"Postoperative Period" were used as English key terms.The search was carried out by a combination of subject terms and free words.Literatures was included according to the inclusion and exclusion criteria,and the Newcastle-Ottawa Scale quality assessment syste(NOS)was used to evaluate the quality of the studies.Twelve papers were finally included.Data analysis in this section was performed with Review manager 5.4 software.The second part:An retrospective analysis of patients who underwent surgical treatment for pelvic organ prolapse at Shandong Provincial Hospital from2019.01.01 to 2021.06.30 was conducted.Information of 277 patients underwent POP surgery was obtained through the case retrieval system,and 183 patients were followed up by telephone,while basic patient information and inpatient treatment were recorded.The patients included were divided into postoperative urinary incontinence(POUI)group、postoperative urinary stress incontinence(POSUI)group and control group according to whether they had urinary incontinence after surgery,and SPSS 26.0 was used for statistical analysis.Results The first part:A total of 12 literatures were included in this study,with a sample size of 3691 cases,including 650 patients with new-onset urinary incontinence.Factors such as body mass index(BMI),menopause,diabetes mellitus,hypertension,pulmonary disease,chronic constipation,anterior vaginal wall prolapse,pelvic organ prolapse stage,and history of hysterectomy were analyzed.The results showed that two factors,BMI and diabetes mellitus,were statistically significant,in subgroup analysis,the history of diabetes mellitus was only statistically significant in people outside the mainland of ChinaThe second part:The total number of patients included in this study was 154.Thirty-four patients(22.08%)presented with new-onset postoperative urinary incontinence,including 28 cases of stress incontinence(18.18%),4 cases of urge incontinence,and 2 cases of mixed incontinence;25 cases of mild incontinence,8 cases of moderate incontinence,and 1 case of severe incontinence.1.The analysis of the POUI group versus the control group In the univariate analysis,differences between the POUI group and the control group were statistically significant for age≥65 years,BMI≥ 25(kg/m2),chronic constipation,giant infant delivered via vaginal delivery,delivery out of hospital,episiotomy,and higher labor intensity.Therefore,the above factors were included in the following multivariat Logistic analysis,and the results showed that constipation(OR=5.498,95%CI:1.266～23.878),episiotomy(OR=5.552,95%CI:1.64～18.793),and BMI ≥25(kg/m2)(OR=3.155,95%CI:1.23～8.089)were independent risk factors for POUI,and age≥65 years,giant infant delivered via vaginal delivery,delivery out of hospital,higher labor intensity were not independent risk factors for POUI.2.In the analysis of the POSUI group and the control group there were statistically significant differences between the POSUI group and the control group based on the results of the univariate analysis for BMI≥ 25(kg/m2),constipation,episiotomy,and higher labor intensity.Therefore,the above factors were included in the multivariate regression analysis,and the results showed that constipation(OR=4.926,95%CI:1.238-19.598),episiotomy(OR=5.976,95%CI:1.926-18.544),and BMI≥25(kg/m2)(OR=3.032,95%CI:1.151-7.99)were independent risk factors for POSUI.Conclusion 1.High BMI and diabetes history are risk factors of urinary incontinence after pelvic organ surgery,while the history of diabetes is only related to the probability of POUI in people outside the mainland region,and the probability of de novo urinary incontinence after surgery in patients in mainland China is not related.2.Chronic constipation,history of episiotomy,and overweight are independent risk factors for POUI.Factors such as the history of episiotomy and chronic constipation did not yield a reliable conclusion in the meta-analysis,which was supplemented in the study in our hospital.3.As the main type of POUI,the risk factors of POSUI include:chronic constipation,history of episiotomy,overweight,which is consistent with the risk factors of POUI,providing a clearer basis for the prevention and treatment of POUI. |
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