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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 許毓昭 | 術前尿動力學檢查是否增加婦女尿失禁病患術後成功率? | 2014/8/29 上午 10:06:59 | 0 |
| 原 文 | 題 目 | Does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta-analysis. |
| 作 者 | Rachaneni S, Latthe P.. | |
| 出 處 | BJOG | |
| 出版日期 | 2014 Jul 15. doi: 10.1111/1471-0528. | |
| 評 論 |
尿動力學查是一項廣泛運用於排尿障礙的檢查項目。對於複雜性排尿障礙，泌尿科醫師常常會藉由尿動力學檢查來鑑別診斷。然而針對尿失禁病患施行尿動力學檢查是否能夠提升手術之成功率，實為讓人有興趣的課題。 目前發表的論文，針對此議題有不同的結論。本篇文章收集四個研究案件，針對其中病例進行分析。研究結果顯示，針對於手術成功率以不同方向來評估。以病人主觀認定來看，手術成功與否並不因是否接受術前尿動力學檢查而有差異。至於手術併發症方面，解尿困難、急尿感也不會因此而有增加。 雖然尿動力學檢查是一個解尿困難常用的檢查，許多醫師甚至病患本身，也會開立或要求術前進行尿動力學檢查，但整體研究分析發現，在應力性尿失禁的病患進行檢查，並不會增加其術後成功的機會，也不會降低併發症的發生率。只要病患術前的表現是以單純應力性尿失禁，或混和型尿失禁，無伴隨其他解尿症狀者，並不一定需要進行檢查。應該由臨床醫師依個別病患病況進行開立，不該是常規的術前檢查項目。 |
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| abstract |
OBJECTIVES: To compare the surgical outcomes in women with SUI or stress-predominant mixed urinary incontinence (MUI) based on urodynamic diagnoses compared with diagnoses based on office evaluation without urodynamics. SEARCH STRATEGY: We searched Cochrane, MedLine, Embase, CINAHL, LILACS, metaRegister of Controlled Trials (mRCT) and Google Scholar databases from inception until March 2013. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing surgical outcomes in women investigated by urodynamics and women who had office evaluation only. DATA COLLECTION AND ANALYSIS: Two independent reviewers (S.R. and P.L.) extracted the data and analysed it using review manager (revman) 5.2 software. MAIN RESULTS: Of the 388 articles identified, only four RCTs met our criteria. The data from one study are as yet unpublished. In the other three RCTs, the women with SUI or stress-predominant MUI were randomised either to office evaluation and urodynamics (n = 388) or to office evaluation only (n = 387). There was no statistical difference in the risk ratio (RR) of subjective cure in the two groups (RR 1.02, 95%CI 0.90-1.15, P = 0.79, I2 = 45%), objective cure (RR 1.01, 95%CI 0.93-1.11, P = 0.28, I2 = 20%) or complications such as voiding dysfunction (RR 1.54, 95%CI 0.61-3.89, P = 0.27, I2 = 18%) or urinary urgency (RR 0.80, 95%CI 0.28-2.3, P = 0.19, I2 = 40%). AUTHORS CONCLUSIONS: In women undergoing primary surgery for SUI or stress-predominant MUI without voiding difficulties, urodynamics does not improve outcomes - as long as the women undergo careful office evaluation. |
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