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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 應力性尿失禁(SUI)手術後導致急迫性尿失禁(UUI)的危險因子評估 | 2010/1/28 下午 03:25:01 | 0 |
| 原 文 | 題 目 | Risk factors associated with urge incontinence after continence surgery |
| 作 者 | Kenton K, Richter H, Litman H, Lukacz E, Leng W, Lemack G, Chai T, Arisco A, Tennstedt S, Steers W; Urinary Incontinence Treatment Network | |
| 出 處 | J Urol. 182(6):2805-9 | |
| 出版日期 | December 2009 | |
| 評 論 |
本篇文章是由美國多所大學共同發表，針對應力性尿失禁手術療效評估研究(SISTEr; Stress Incontinence Surgical Treatment Efficacy Trial)所做的分析，試圖找出應力性尿失禁(SUI)手術後導致急迫性尿失禁(UUI)的危險因子。臨床上應力性尿失禁手術後，引起術前並沒有存在的急迫性症狀，我們稱之為「De novo urge symptoms」；根據統計其發生率可高達12%-30%，而UUI則是更為嚴重的併發症。作者發現手術方式使用sling procedure比Burch procedure高出接近兩倍的機率需要術後治療UUI(odds ratio 1.72, 95%CI 1.16-2.54, p=0.007) ；而如果婦女術前有急尿症狀，或UDS檢查有detrusor overactivity，或術前有服用抗乙醯膽鹼藥物病史者也較容易發生術後UUI；本篇文章除上述結論外，另外強調混合型尿失禁的低治癒率應隱含其可能有不同的underlying pathophysiology，因此對於此類病人在術前評估更要特別小心。類似的文章Dr. Botros et al. 發表於2007 Neurourology and Urodynamics 的研究中亦曾提到使用transobturator procedures手術方式比midurethral sling procedures較不易發生術後de novo UUI，也觀察到手術方式與術後UUI的發生有關。 應力性尿失禁手術在目前是相當普遍的手術，但當醫師為病人施行手術之後，病患卻告訴醫師她仍然會漏尿，而且是更嚴重的急迫性尿失禁時，相信對病患及醫師都是一件非常令人感到挫折的事情；因此手術前一定要詳細的評估並向病患告知術後可能發生的併發症－包括術前無法預測的部分。 |
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| abstract |
PURPOSE: We identified preoperative factors associated with bothersome urge urinary incontinence after incontinence surgery (Burch or sling). MATERIALS AND METHODS: Postoperative urge urinary incontinence was defined as treatment for urge urinary incontinence 6 or more weeks after surgery. Variables thought to affect postoperative urge urinary incontinence included age, race, prior incontinence surgery or treatment, body mass index, pelvic organ prolapse quantification stage, frequency of stress and urge symptoms, incontinence episode frequency, concomitant surgery and urodynamic findings. Bivariate logistic regression models were fit in which each covariate was controlled for separately to ascertain potential importance. After controlling for surgery several baseline factors were associated with postoperative urge urinary incontinence (p <0.10) and used in multivariable modeling, including age, body mass index, prior incontinence surgery, prior anticholinergic medication, stress and urge symptom scores, detrusor overactivity and detrusor pressure at maximum flow. RESULTS: Of 655 women who had surgical re-treatment for stress urinary incontinence 34 were excluded from study. Participants had a mean +/- SD age of 51 +/- 10 years. Stress and urge symptom scores were 19.3 +/- 4.6 and 6.4 +/- 3.9, respectively. Of the women 89 (14%) had prior incontinence surgery and 165 (27%) had taken anticholinergic medication. A total of 132 women (21%) required treatment for postoperative urge urinary incontinence (50 Burch, 82 sling). Odds of treatment for urge urinary incontinence after surgery were significantly higher after sling compared to Burch (OR 1.72, 95% CI 1.16-2.54, p = 0.007). A 10-point increase in preoperative Medical, Epidemiologic, and Social Aspects of Aging urge score, prior anticholinergic use and detrusor overactivity all independently increased the odds of urge urinary incontinence. CONCLUSIONS: Women are almost twice as likely to need treatment for postoperative urge urinary incontinence after sling than Burch. Women with preoperative urge, detrusor overactivity or prior use of anticholinergic medications are more likely to have bothersome urge urinary incontinence postoperatively. |
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