盆腔脏器脱垂术前隐匿性尿失禁评估及手术治疗策略的研究进展

Research Progress on Preoperative Assessment of Concealed Urinary Incontinence and Surgical Treatment Strategies for Pelvic Organ Prolapse

摘要: 盆腔脏器脱垂(Pelvic Organ Prolapse, POP)与压力性尿失禁(Stress Urinary Incontinence, SUI)是两种高度共存的盆底功能障碍性疾病。隐匿性尿失禁(Occult Stress Urinary Incontinence, OSUI)作为其间的一种特殊类型，指患者在脱垂状态下无漏尿症状，但在脱垂复位后出现SUI表现。OSUI的存在使POP手术决策变得复杂：若未识别OSUI，术后可能发生新发SUI (de novo SUI)；若对所有患者常规行预防性抗尿失禁手术，又可能导致过度治疗。本文从评估技术视角、风险预测视角和临床决策视角出发，系统综述OSUI的病理机制、诊断方法、预测模型及治疗策略的研究进展。研究表明，术前OSUI的阳性预测值约为40%，但其阴性预测值可高达91%，这一特征决定了OSUI评估的核心价值在于“排除风险”而非“确定诊断”。当前评估手段仍以咳嗽压力试验和尿动力学检查为主，盆底超声作为无创补充手段展现出潜力，但缺乏统一的诊断标准和截断值。在治疗策略上，同期行抗尿失禁手术可显著降低术后SUI发生率，但需权衡过度治疗的风险。未来研究应致力于建立标准化的OSUI诊断流程、开发更精准的预测模型，并通过高质量随机对照试验明确不同人群的最佳治疗策略。

Abstract: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two highly coexisting pelvic floor functional disorders. Occult stress urinary incontinence (OSUI), as a special type among them, refers to the situation where patients have no leakage symptoms during prolapse but exhibit SUI manifestations after prolapse is restored. The existence of OSUI complicates the decision-making for POP surgeries: if OSUI is not identified, new-onset SUI (de novo SUI) may occur after surgery; if preventive anti-incontinence surgeries are routinely performed for all patients, it may lead to over-treatment. This article reviews the research progress in the pathogenesis, diagnostic methods, prediction models, and treatment strategies of OSUI from the perspectives of assessment techniques, risk prediction, and clinical decision-making. The study shows that the positive predictive value of OSUI before surgery is approximately 40%, but its negative predictive value can reach up to 91%. This characteristic determines that the core value of OSUI assessment lies in “risk exclusion” rather than “diagnosis confirmation”. Current assessment methods mainly rely on cough pressure tests and urodynamic examinations, and pelvic floor ultrasound as a non-invasive supplementary method shows potential. However, there is a lack of unified diagnostic criteria and cut-off values. In terms of treatment strategies, concurrent anti-incontinence surgeries can significantly reduce the incidence of SUI after surgery, but the risk of over-treatment needs to be weighed. Future research should focus on establishing standardized OSUI diagnostic procedures, developing more accurate prediction models, and conducting high-quality randomized controlled trials to clarify the best treatment strategies for different populations.