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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鄒頡龍 | 減重 – 一種創新而且有效治療尿失禁的方法 | 2005/7/29 下午 10:43:01 | 3 |
| 原 文 | 題 目 | WEIGHT LOSS: A NOVEL AND EFFECTIVE TREATMENT FOR URINARY INCONTINENCE |
| 作 者 | SUBAK, LESLEE L.*; WHITCOMB, EMILY; SHEN, HUI; SAXTON, JOAN; VITTINGHOFF, ERIC; BROWN, JEANETTE S. From the Department of Obstetrics, Gynecology and Reproductive Sciences (LLS, JSB), Department of Epidemiology and Biostatistics (LLS, HS, EV, JSB), Department of Medicine (JS), and Department of Urology (JSB), University of California, San Francisco, the Weight Management Program, California Pacific Medical Center (JS), San Francisco, and Department of Reproductive Medicine, University of California, San Diego (EW), San Diego, California |
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| 出 處 | The Journal of Urology: Volume 174(1), July 2005, pp 190-195 | |
| 出版日期 | July 2005 | |
| 評 論 |
介紹及評論： 體重過重的婦女減肥能治療尿失禁嗎？這篇論文給了肯定的答案。 本文作者針對體重過重，且每週有4次尿失禁之肥胖婦女研究，其中24位先接受了3個月的液體飲食減重計畫，另24位在「等待名單」的患者則在研究計畫進行第三個月時開始減重。完成減重計畫後，所有接受治療者繼續接受6個月追蹤。 接受治療的婦女治療前平均97公斤，每星期有21次尿失禁；「減重治療」的婦女減少了16公斤，「等待名單」的患者減少了0公斤。「減重治療」婦女每星期尿失禁的頻率減少60％，而「等待名單」的患者減少15％。當「等待名單」的婦女成功減重之後，每星期尿失禁的頻率同樣明顯減少，達到71％之多。所有40位減重後婦女尿失禁頻率平均減少54％，且在6個月的追蹤過程持續維持。 這篇研究證實體重過重的婦女減肥對治療尿失禁的成效，其結果並不令人意外。肥胖是造成骨盆底肌肉鬆弛與尿失禁的原因之一，若能成功減重，膀胱受到腹部油脂壓迫力量減少，症狀自然可能減輕。然而臨床上，筆者多次建議體重過重的患者減重，得到的回答多是：「要是減肥簡單，我早就減了！」或是「我越減越肥，早就放棄了」，真正能成功減重的非常少。此外，「復胖」是重要的問題，許多藉由「非常手段」瘦下來的過重者，一旦恢復「正常飲食」與「日常作息」後，「復胖」的機會相當高。筆者猜測，這篇論文作者的下一個研究，可能就是看「復胖」婦女的尿失禁症狀，是否又和減重前一樣。 「成功減重」是所有體重過重的願望，不止能減少尿失禁症狀，對心血管疾病、新陳代謝等慢性病之防治都有正面幫助。若能配合凱格爾運動等骨盆底肌肉復健，效果應會更好。 |
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| abstract |
Purpose: We evaluated the effect of weight loss on urinary incontinence (UI) in overweight and obese women. Materials and Methods: A randomized, controlled clinical trial was conducted among overweight and obese women experiencing at least 4 UI episodes per week. Women were randomly assigned to a 3-month liquid diet weight reduction program (24 in the immediate intervention group) or a wait-list delayed intervention group (24 in the wait-list control group). Participants in the wait-list control group began the weight reduction program in month 3 of the study. All women were followed for 6 months after completing the weight reduction program. Wilcoxon tests were used to compare intergroup differences in change in weekly UI episodes and quality of life scores. Results: A total of 48 women were randomized and 40 were assessed 3 months after randomization. Median (with 25% to 75% interquartile range [IQR]) baseline age was 52 years (IQR 47 to 59), weight was 97 kg (IQR 87 to 106) and UI episodes were 21 weekly (IQR 11 to 33). Women in the immediate intervention group had a 16 kg (IQR 9 to 20) weight reduction compared with 0 kg (IQR -2 to 2) in the wait-list control group (p <0.0001). The immediate intervention group experienced a 60% reduction (IQR 30% to 89%) in weekly UI episodes compared with 15% (IQR -9% to 25%) in the wait-list control group (p <0.0005) and had greater improvement in quality of life scores. Stress (p =0.003) and urge (p =0.03) incontinent episodes decreased in the immediate intervention vs wait-list control group. Following the weight reduction program the wait-list control group experienced a similar median reduction in weekly UI episodes (71%). Among all 40 women mean weekly UI episodes decreased 54% (95% CI 40% to 69%) after weight reduction and the improvement was maintained for 6 months. Conclusions: Weight reduction is an effective treatment for overweight and obese women with UI. Weight loss of 5% to 10% has an efficacy similar to that of other nonsurgical treatments and should be considered a first line therapy for incontinence. |
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| 回覆發表 | 回覆討論主題內容 | 最後發表 |
| 鄒頡龍 |
非常贊成以上兩位的觀點， 1. 減肥對尿失禁有防治作用，但是方法很重要，有所得，也有所失，必須謹慎評估。 2.減肥不容易，要持之以恆更是不容易。看來「尿失禁防治」的設立，除了「凱格爾運動訓練」是否還應該包括「減重特訓中心」？ 尿失禁的治療是全面的，不僅開藥，不僅手術，而是全方位的照顧，不是嗎？ |
2005/10/2 下午 07:05:07 |
| 王炯珵 |
obesity surgery is an effective method to reduce body weight. But the surgical risk should be evaluated before operation. | 2005/8/30 下午 10:54:13 |
| 林登龍 |
如何減肥對病人而言才是更困難的挑戰，有誰有丿步可讓尿失禁的病人減肥? | 2005/8/22 下午 02:31:02 |