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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 姜宜妮 | 影響應力性尿失禁手術治療結果的預後因子 | 2010/5/30 下午 05:09:43 | 0 |
| 原 文 | 題 目 | Update of AUA guideline on the surgical management of female stress urinary incontinence. |
| 作 者 | Dmochowski RR, Blaivas JM, Gormley EA, Juma S, Karram MM, Lightner DJ, et al. | |
| 出 處 | J Urol 2010 May;183(5):1906. | |
| 出版日期 | 2010 May | |
| 評 論 |
手術治療對於應力性尿失禁有立即而良好的療效。但回顧過去的文獻，對於影響治療成功與否的預測因子，仍沒有具有顯著科學證據的定論。可能影響手術預後的因子包括：社經條件(年齡、種族、職業、教育程度、婚姻狀態、家庭收入)、過去病患是否接受過骨盆腔或尿失禁手術、生育次數、體重、停經、糖尿病、抽菸、理學檢查結果、尿路動力學檢查結果和麻醉方法。亦有研究顯示，術前急尿症狀(urgency)較明顯的病人，發生尿失禁手術治療失敗的比例較高。 根據2010年五月刊登的美國泌尿科醫學會女性應力性尿失禁手術治療指南，開腹式恥骨後懸吊術(open retropubic suspension)術後12-23個月的成功率約在82%，腹腔鏡懸吊術的成功率則約69%；但此結果並沒有達到統計上的差異。自體筋膜吊帶術後12-23個月的成功率約74%，放置膀胱頸的人工網膜吊帶成功率約73%，放置於中段尿道的人工網膜吊帶成功率則為81-84%，但更長期的結果目前仍沒有定論，需要進一步的研究。 |
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| abstract |
PURPOSE: We d the 1997 American Urological Association guideline on female stress incontinence. MATERIALS AND METHODS: MEDLINE searches of English language publications from 1994 and new searches of the literature published between December 2002 and June 2005 were performed using identified MeSH terms. Articles were ed for the index patient defined as the otherwise healthy woman who elected to undergo surgery to correct stress urinary incontinence or the otherwise healthy woman with incontinence and prolapse who elected to undergo treatment for both conditions. RESULTS: A total of 436 articles were identified as suitable for inclusion in the meta-analysis, and an additional 155 articles were suitable for complications data only due to insufficient followup of efficacy outcomes in the latter reports. Surgical efficacy was defined using outcomes pre-specified in the primary evidence articles. Urgency (resolution and de novo) was included as an efficacy outcome due to its significant impact on quality of life. The primary efficacy outcome was resolution of stress incontinence measured as completely dry (cured/dry) or improved (cured/improved). Complications were analyzed similarly to the efficacy outcomes. Subjective complications (pain, sexual dysfunction and voiding dysfunction) were also included as a separate category. CONCLUSIONS: The surgical management of stress urinary incontinence with or without combined prolapse treatment continues to evolve. New technologies have emerged which have impacted surgical treatment algorithms. Cystoscopy has been added as a standard component of the procedure during surgical implantation of slings. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. 1. Deval B, Jeffry L, Al Najjar F, Soriano D and Darai E: Determinants of patient dissatisfaction after a tension-free vaginal tape procedure for urinary incontinence. J Urol 2002; 167: 2093. 2. Black NA and Downs SH: The effectiveness of surgery for stress incontinence in women: a systematic review. Br J Urol 1996; 78: 497. 3. Richter HE, Diokno A, Kenton K, Norton P, Albo M, Kraus S, et al. Predictors of treatment failure 24 months after surgery for stress urinary incontinence. J Urol 2008 Mar;179(3):1024. |
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