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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李彥羲 | 探究肥胖與尿失禁之關係與減重對尿失禁改善之效益分析 | 2019/12/30 下午 04:36:24 | 0 |
| 原 文 | 題 目 | Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction |
| 作 者 | Tom Marcelissen, Ralf Anding, Marcio Averbeck, Ann Hanna‐Mitchell, Sajjad Rahnama’i, Linda Cardozo | |
| 出 處 | Neurourology and Urodynamics. 2019;38:S18-S24. | |
| 出版日期 | Dec, 2019 | |
| 評 論 |
肥胖問題是現今全球健康所面臨的重大挑戰，從實際的數字來看，全世界的肥胖盛行率從1975年至2016年已經上升了3倍之多。根據近期的WHO報告，全球19億人口處於過重(身體質量指數BMI超過25)的狀態，男性過重比率39%，女性為40%，至於全球肥胖(身體質量指數BMI超過30)的部分，人口接近6億5千萬，男性肥胖比率11%，女性稍高為15%。在先前發表過的流行病學研究中已發現，肥胖是尿失禁的一個強力危險因子之一，且肥胖在美國導致了一年超過30萬的死亡，與多重疾病如高血壓、心血管疾病、糖尿病、癌症、憂鬱症等都有相關性。因此探究肥胖以及減重對尿失禁的關係及影響就顯得益發重要。 綜合本篇研究發現，構造性因素及代謝性因素對肥胖的產生都扮演重要的腳色，肇因於內臟脂肪組織釋放細胞激素造成全身性的發炎反應以及氧化壓力之形成。不論是內科式的減重計畫或是外科式的減重手術，均可以改善尿失禁的症狀。其中多篇的研究也進一步發現採取外科減重手術可以減少尿失禁次數，而且體重減輕的程度與尿失禁症狀的改善呈正相關的關係。換言之，減重越多則尿失禁的改善會更顯著。研究也顯示，雖然缺乏長期的追蹤研究，尿失禁手術的成功率受身體質量指數BMI的影響並不大。 綜合結論來說，肥胖與應力性尿失禁或急迫性尿失禁的盛行率增加都有強烈相關性，減重與兩種尿失禁的症狀改善都有明確效益，在尿失禁的治療諮商中務必要列入其中。此外，術前身體質量指數BMI的高低並不會影響尿失禁手術的成功率，也就是說並非肥胖的患者接受尿失禁手術的成功率會較低。 |
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| abstract |
Aims: To evaluate the relationship between obesity and urinary incontinence (UI) and to determine the effect of weight reduction on the severity of incontinence. Methods: This is a consensus report of the proceedings of a Research Proposal from the annual International Consultation on Incontinence‐Research Society, 14 June to 16 June, 2018 (Bristol, UK): “What are the relationships between obesity and UI, and the effects of successful bariatric surgery?” Results: Obesity is an increasing problem worldwide and is associated with many adverse effects on health and quality of life. From both translational and clinical studies, there is a strong relationship between obesity and the occurrence of UI. Both mechanical and metabolic factors seem to play an important role including systemic inflammation and oxidative stress due to the release of cytokines in visceral adipose tissue. The success rate of anti‐incontinence surgery does not seem to be greatly affected by body mass index (BMI), although reliable data and long term follow‐up are currently lacking. Both weight reduction programs and bariatric surgery can result in amelioration of UI. Various studies have shown that weight loss (particularly that associated with bariatric surgery) can reduce incontinence, and the degree of weight loss is positively correlated with improvement in symptoms. Conclusions: Obesity is strongly associated with an increased prevalence of both stress and urgency UI. The treatment outcome does not seem to be highly dependent on BMI. Weight reduction is positively correlated with improvement of incontinence symptoms and therefore should be advocated in the management. |
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