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Testing périnéal et incontinence urinaire masquée dans l’évaluation clinique des prolapsus génitaux

Pelvic floor muscle strength and masked incontinence in clinical assessment of pelvic organ prolapse

  • Article De Synthèse / Review Article / Théma
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Pelvi-périnéologie

Résumé

Le toucher vaginal est utilisé en routine pour évaluer la force de contraction des muscles pelvi-périnéaux, et différents systèmes de cotation ont été décrits, comme l’échelle d’Oxford modifiée. Toutefois, cette méthode d’évaluation clinique est peu reproductible et elle n’est pas valide pour quantifier de façon objective la force développée par ces muscles. De plus, elle fait preuve d’un très faible pouvoir de discrimination quand on la compare à la dynamométrie, c’est-à-dire qu’à une même valeur de force peuvent correspondre plusieurs cotations au testing périnéal (cotation de 0 à 5 selon le système d’Oxford modifié), ce qui traduit un mauvais pouvoir de discrimination. Ces limitations importantes de la valeur intrinsèque de ce test clinique doivent être prises en compte par les chercheurs et les cliniciens. L’incontinence urinaire occulte (ou latente) est définie par des fuites à l’effort apparaissant uniquement après réduction d’un prolapsus génital. De nombreuses méthodes de réduction ont été décrites. C’est la technique de réduction par hémivalve de spéculum qui est la plus sensible. L’incidence d’une incontinence urinaire postopératoire de novo n’est que de 0 à 2 % en cas d’absence d’incontinence urinaire masquée préopératoire. À l’opposé, la présence d’une incontinence urinaire masquée en préopératoire est associée à une incidence de 20 à 60 % d’incontinence urinaire à l’effort de novo postopératoire. Toutefois, l’existence de possibles effets secondaires d’un geste urinaire associé justifie une discussion entre une chirurgie en un temps et une approche en deux temps.

Abstract

Vaginal palpation is commonly used in clinical practice to evaluate pelvic floor muscle strength, and several grading systems, such as the Modified Oxford grading system, have been developed. However, the clinical method is not reproducible, sensitive and valid for measuring pelvic floor muscle strength. Furthermore, even if the dynamometric mean forces of the pelvic floor muscle increase across subsequent categories of digital assessment (0 to 5, Modified Oxford grading system), the force values between two adjacent categories do not differ enough (poor discrimination). These severe limitations of clinical digital assessment should be considered by clinicians and researchers. Stress incontinence on prolapse reduction (occult or latent stress incontinence) is defined as follows: stress incontinence only observed after the reduction of a co-existent prolapse. Many methods of prolapse reduction are described. Reduction using a speculum valve is the more sensitive method. The incidence of stress urinary incontinence manifesting after prolapse surgery is low (0–2%), when no occult stress incontinence is observed pre-operatively. On the other hand, the presence of occult stress incontinence during clinical exam is associated with a high incidence of post-operative de novo stress incontinence (from 20 up to 60%). However, the possible side effects of an incontinence surgery justify a discussion regarding using a one-step or a two-step approach.

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Authors and Affiliations

  1. Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, F-92140, Clamart, France

    X. Deffieux, C. Trichot, L. -M. Bontoux, G. Demoulin, T. Thubert & E. Faivre

  2. ER6, neurophysiologie de la miction et des troubles vésicaux d’origine neurologique, UMPC, Paris, France

    X. Deffieux & T. Thubert

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  1. X. Deffieux
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  2. C. Trichot
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  3. L. -M. Bontoux
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  4. G. Demoulin
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  5. T. Thubert
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  6. E. Faivre
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Correspondence to X. Deffieux.

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Public/Intérêt: Chercheurs/Faible. Cliniciens/Indispensable. Enseignants/Indispensable. Étudiants/Indispensable. Autres professions de santé/Majeur. Cadres santé publique/Faible.

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Deffieux, X., Trichot, C., Bontoux, L.M. et al. Testing périnéal et incontinence urinaire masquée dans l’évaluation clinique des prolapsus génitaux. Pelv Perineol 6, 59–64 (2011). https://doi.org/10.1007/s11608-011-0362-1

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  • DOI: https://doi.org/10.1007/s11608-011-0362-1

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