Background

The association of pelvic organ prolapse with overactive bladder and other lower urinary tract symptoms, and the natural history of those symptoms are not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and lower urinary tract symptoms.

Objective

This study primarily aimed to determine the baseline association between lower urinary tract symptoms and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse. Secondary aims were to explore associations between lower urinary tract symptoms and prolapse treatment. We hypothesized that: (1) prolapse is associated with the presence of lower urinary tract symptoms, (2) lower urinary tract symptoms are stable over time in patients with and without prolapse, and (3) prolapse treatment is associated with lower urinary tract symptom improvement.

Study Design

Women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study with adequate 12-month follow-up data were included. Prolapse and lower urinary tract symptom treatment during follow-up was guided by standard of care. Outcome measures included the Lower Urinary Tract Symptoms Tool total severity score (in addition to overactive bladder, obstructive, and stress urinary incontinence subscales) and Urogenital Distress Inventory-6 Short Form. Prolapse (yes or no) was defined primarily when Pelvic Organ Prolapse Quantification System points Ba, C or Bp were >0 (beyond the hymen). Mixed-effects models with random effects for patient slopes and intercepts were fitted for each lower urinary tract symptom outcome and prolapse predictor, adjusted for other covariates. The study had >90% power to detect differences as small as 0.4 standard deviation for less prevalent group comparisons (eg, prolapse vs not).

Results

A total of 371 women were analyzed, including 313 (84%) with no prolapse and 58 (16%) with prolapse. Women with prolapse were older (64.6±8.8 vs 55.3±14.1 years; P<.001) and more likely to have prolapse surgery (28% vs 1%; P<.001) and pessary treatment (26% vs 4%; P<.001) during the study. Average baseline Lower Urinary Tract Symptoms Tool total severity scores were lower (fewer symptoms) for participants with prolapse compared with those without (38.9±14.0 vs 43.2±14.0; P=.036), but there were no differences in average scores between prolapse groups for other scales.

For all urinary outcomes, average scores were significantly lower (improved) at 3 and 12 months compared with baseline (all P<.05). In mixed-effects models, there were no statistically significant interactions between pelvic organ prolapse measurement and visit and time-dependent prolapse treatment groups (P>.05 for all regression interaction coefficients). The Lower Urinary Tract Symptoms Tool obstructive severity score had a statistically significant positive association with Pelvic Organ Prolapse Quantification System Ba, Bp, and point of maximum vaginal descent. The Lower Urinary Tract Symptoms Tool total severity scale had a statistically significant negative association with Pelvic Organ Prolapse Quantification System Ba and point of maximum vaginal descent. No other associations between prolapse and lower urinary tract symptoms were significant (P>.05 for all regression coefficients). Symptom differences between prolapse groups were small: all regression coefficients (interpretable as additive percentage change in each score) were between -5 and 5 (standard deviation of outcomes ranged from 14.0–32.4).

Conclusion

Among treatment-seeking women with urinary symptoms, obstructive symptoms were positively associated with prolapse, and overall lower urinary tract symptom severity was negatively associated with prolapse. Lower Urinary Tract Symptoms Tool scores improved over 12 months regardless of prolapse status, including in those with treated prolapse, untreated prolapse, and without prolapse.

中文翻译：

---

盆腔器官脱垂寻求治疗的女性下尿路症状的自然史；下尿路功能障碍症状研究网络 (LURN)

 背景

盆腔器官脱垂与膀胱过度活动症和其他下尿路症状的关系以及这些症状的自然史尚不清楚。先前的横断面研究表明脱垂和下尿路症状之间存在相互矛盾的关系。

 客观的

本研究的主要目的是确定下尿路症状与脱垂之间的基线关联，并评估患有和不患有脱垂的女性在 12 个月内症状的纵向差异。次要目的是探讨下尿路症状与脱垂治疗之间的关联。我们假设：（1）脱垂与下尿路症状的存在相关，（2）有或没有脱垂的患者下尿路症状随着时间的推移是稳定的，（3）脱垂治疗与下尿路症状相关改进。

 学习规划

纳入下尿路功能障碍症状研究网络观察队列研究的女性，并有足够的 12 个月随访数据。随访期间脱垂和下尿路症状的治疗以标准护理为指导。结果测量包括下尿路症状工具总严重程度评分（除了膀胱过度活动症、梗阻性尿失禁和压力性尿失禁分量表）和泌尿生殖窘迫清单 6 简表。脱垂（是或否）主要定义为当盆腔器官脱垂定量系统点 Ba、C 或 Bp >0（超出处女膜）时。针对每个下尿路症状结果和脱垂预测因子拟合对患者斜率和截距具有随机效应的混合效应模型，并针对其他协变量进行调整。对于不太常见的组比较（例如，脱垂与不脱垂），该研究具有 >90% 的功效来检测小至 0.4 标准差的差异。

 结果

共有 371 名女性接受了分析，其中 313 名（84%）没有脱垂，58 名（16%）有脱垂。患有脱垂的女性年龄较大（64.6±8.8 vs 55.3±14.1 岁； P <.001），并且更有可能接受脱垂手术（28% vs 1%； P <.001）和子宫托治疗（26% vs 4%； P <.001) 在研究期间。与没有脱垂的参与者相比，有脱垂的参与者的平均基线下尿路症状工具总严重程度评分较低（症状较少）（38.9±14.0 vs 43.2±14.0； P =.036），但脱垂组之间的平均评分没有差异对于其他尺度。

对于所有泌尿结果，与基线相比，第 3 个月和第 12 个月的平均评分显着降低（改善）（所有P <.05）。在混合效应模型中，盆腔器官脱垂测量与就诊和时间依赖性脱垂治疗组之间没有统计学上显着的相互作用（所有回归相互作用系数P > 0.05）。下尿路症状工具梗阻严重程度评分与盆腔器官脱垂定量系统 Ba、Bp 和最大阴道下降点呈统计学显着正相关。下尿路症状工具总严重程度量表与盆腔器官脱垂定量系统 Ba 和最大阴道下降点呈统计显着负相关。脱垂和下尿路症状之间没有其他显着相关性（所有回归系数P > 0.05）。脱垂组之间的症状差异很小：所有回归系数（可解释为每个分数的累加百分比变化）都在 -5 到 5 之间（结果的标准差范围为 14.0-32.4）。

 结论

在有泌尿系统症状的寻求治疗的女性中，梗阻症状与脱垂呈正相关，总体下尿路症状严重程度与脱垂呈负相关。下尿路症状工具评分在 12 个月内有所改善，无论脱垂状况如何，包括已治疗脱垂、未治疗脱垂和未脱垂的患者。