A randomized comparison of vesicourethral function after laparoscopic hysterectomy with and without vaginal cuff suspension.

摘要

STUDY OBJECTIVE: To compare vesicourethral function following laparoscopic hysterectomy (LH) with and without vaginal cuff suspension. DESIGN: Prospective study (Canadian Task Force classification I). SETTING: Tertiary teaching hospital. PATIENTS: Sixty-eight women scheduled for LH randomly assigned to either LH without vaginal cuff suspension (LH group; n = 36) or LH with suspension (LHS group; n = 32). INTERVENTION: All subjects received urinalysis, pelvic examination, Q-tip test, introital ultrasonography, and a urinary questionnaire before and 6 months after surgery. MEASUREMENTS AND MAIN RESULTS: The prevalence of stress urinary incontinence (SUI) decreased significantly from 46.9% (n = 15) preoperatively to 18.8% (n = 6) postoperatively in the LHS group (p = .022), but this was not so in the LH group. Similarly, the mean straining urethral angle and the number of women exhibiting bladder neck (BN) hypermobility significantly decreased after surgery in only the LHS group (p <.05; p <.01, respectively). During straining, the postoperative position of the BN localized more dorsally (p <.01), and its ventral mobility decreased significantly (p <.01) in the LH group. In the LHS group, significant postoperative reduction was found in both ventral and caudal movements of the BN during stress (p <.01), causing a more cranial and dorsal position of the BN (p <.01). CONCLUSION: Laparoscopic hysterectomy with cuff suspension strengthens the traction effect on the endopelvic fascia, reducing both BN mobility during stress and the chance of SUI. However, simply performing a cuff suspension is not adequate for the treatment of severe SUI.