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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 劉緯陽 | 無尿失禁的婦女於接受骨盆脫垂修補手術時，應否先接受預防性Burch Colposuspension 抗尿失禁手術：於隨機分配控制分組下八年追蹤結果 | 2011/5/29 下午 03:50:34 | 0 |
| 原 文 | 題 目 | Pelvic Organ Prolapse Repair With and Without Prophylactic Concomitant Burch Colposuspension in Continent Women: A Randomized, Controlled Trial With 8-Year Followup |
| 作 者 | Elisabetta Costantini, Massimo Lazzeri, Vittorio Bini, Michele Del Zingaro, Alessandro Zucchi and Massimo Porena | |
| 出 處 | J Urol 2011; 185: 2236-2240, | |
| 出版日期 | June, 2011 | |
| 評 論 |
婦女骨盆脫垂比率會隨年齡而增加，經統計這其中於60歲以上的婦女有0.31% 會需要接受骨盆脫垂修補手術。在過去婦產科醫師於做經腹腔骨盆脫垂修補手術時多會同時做Burch Colposuspension 來預防尿失禁。但針對僅有骨盆脫垂但並無尿失禁的婦女是否應做預防性的Burch Colposuspension來預防尿失禁。於過去Pelvic Floor Network有過短期約二年的Randomized Controlled Trial；告訴我們婦女在接受骨盆脫垂修補手術時有做Burch Colposuspension，於短期追蹤下似乎有預防應力性尿失禁的效果，但於長期觀察下是否如此於過去並無任何實證醫學的證據來佐證。 這篇文章主要強調持續追蹤八年的結果，且是一篇有證據力的Randomized Controlled Study( EBM level I)。研究設計主要是將婦女有骨盆脫垂合併有尿失禁分為一組，而另一組則為骨盆脫垂但無尿失禁。各組婦女於接受經腹腔骨盆脫垂修補手術時隨機接受有或無Burch Colposuspension，術後追蹤八年並統計結果。 結果顯示無尿失禁的婦女於接受骨盆脫垂修補手術時，不管有無同時做Burch Colposuspension，於長期追蹤八年下並不會影響之後發生尿失禁的機會，也就是兩組結果並無統計學上的差異。所以對於無尿失禁的婦女於接受經腹腔骨盆脫垂修補手術時，作者對於同時做Burch Colposuspension 來預防尿失禁的方法深表懷疑。 這篇文章是探討經腹腔骨盆脫垂修補手術，另外更可進一步省思的是針對目前流行的pelvic floor mesh repairment (經陰道手術)於無合併尿失禁的婦女，是否應同時做TVT或TVT-O來預防尿失禁，目前仍期待有相關Randomized Controlled Study 來告訴大家結果。 |
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| abstract |
Purpose: We reevaluated and brought up to date the 8-year follow up of a previous published, randomized, controlled trial of the impact of Burch colposuspension as a prophylactic anti-incontinence procedure in patients without urinary incontinence who underwent abdominal pelvic organ prolapse repair. Materials and Methods: A total of 66 continent women with pelvic organ prolapse were randomly assigned to abdominal pelvic organ prolapse repair and concomitant Burch colposuspension in 34 (group 1) or pelvic organ prolapse repair alone without an anti-incontinence procedure in 32 (group 2). Primary study end points were the anatomical outcome and changes in incontinence status. Secondary end points were changes in subjective symptoms and quality of life. Results: Median followup was 97 months (range 72 to 134). Three group 1 and 1 group 2 patients were lost to followup. Three group 1 patients had a stage I rectocele and 1 had a stage I cystocele. Four group 2 patients had a stage I rectocele and 3 had a stage I cystocele. Nine of 31 group 1 patients (29%) were incontinent compared with 5 of 31 (16%) in group 2 (p _ 0.553). In group 1 all except 1 patient were successfully treated for voiding dysfunction. Storage symptoms had disappeared in 1 patient and de novo storage symptoms had developed in 2 since the previous followup. De novo incontinence developed in 2 group 2 patients after midterm outcomes were reported. Median Urogenital Distress Inventory-6 and Incontinence Impact on Quality of Life-7 scores were improved in all groups at last followup (p 0.0001). Conclusions: Long-term results cast doubt on whether Burch colposuspension should be done during pelvic organ prolapse repair in continent women. |
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