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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 高育琳 | Predictors of Treatment Failure 24 Months After Surgery for Stress Urinary Incontinence | 2008/4/24 下午 04:59:43 | 0 |
| 原 文 | 題 目 | Predictors of Treatment Failure 24 Months After Surgery for Stress Urinary Incontinence |
| 作 者 | Richter, Holly E; Diokno, Ananias; Kenton, Kimberly; Norton, Peggy; Albo, Michael; Kraus, Stephen; Moalli, Pamela; Chai, Toby Ci; Zimmern, Philippe; Litman, Heather; Tennstedt, Sharon; Urinary Incontinence Treatment Network | |
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應力性尿失禁的手術治療，從早期的懸吊式手術至目前蔚為風潮的sling procedure，提供了病人快速又有效的治療結果。但是因為手術術式的不同或是病人本身情況的不同（例如：病人BMI、骨盆脫垂的嚴重度、之前的應力性尿失禁手術等）或是定義尿失禁的不一致及追蹤時間的長短，造成報告的手術失敗率可高達74％。 由包含泌尿科及婦女泌尿科的醫師組成的Urinary Incontinence Treatment Network在2005年的Urology發表他們所design的Stress Incontinence Surgical Treatment Efficacy Trail（SISTEr）。這是一個Multicenter randomized prospetic trail，以Burch colposuspension or autologus rectus sling 為治療的術式、追蹤2年的治療結果。他們的第一個結論發表在2007年的N Engl J Med，是Sling procedure之成功率優於 Burch operation。 這是他們的第二篇論文探討接受這兩種術式後兩年，treatment failure發生尿失禁的可能因素。之前的學者提到術後兩年，造成手術失敗的危險因子有病人的年齡、BMI、prior UI surgery、prior hystrectomy、DM等。在這篇randomized controlled trail 之報告只有high urge score、high degree of prolapse及menopause without hormone replacement therapy會增加手術的失敗率。這是一個可信度相高的結論。 所以當我們與病人討論手術的術式時，尤其是選擇Burch or sling procedure時，更應注意到病人的hormone status及可能同時存在的pelvic floor prolapse及urge incontinence，如此才能提高病人的滿意度及手術的成功率。 這個Multisite treatment group在J U 4月份也報告了Urodynamic measures do not predict stress continence outcomes after surgery for stress urinary incontinence in selected women |
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| abstract |
Purpose: We identified baseline demographic and clinical factors associated with treatment failure after surgical treatment of stress urinary incontinence. Materials and Methods: Data were obtained from 655 women randomized to Burch colposuspension or autologous rectus sling. Of those, 543 (83%) had stress failure status assessed at 24 months (269 Burch, 274 sling). Stress failure (261) was defined as self-report of stress urinary incontinence by the Medical, Epidemiological, and Social Aspects of Aging questionnaire, positive stress test or re-treatment for stress urinary incontinence. Nonstress failure (66) was defined as positive 24-hour pad test (more than 15 ml) or any incontinent episodes by 3-day voiding diary with none of the 3 criteria for stress failure. Subjects not meeting any failure criteria were considered a treatment success (185). Adjusting for surgical treatment group and clinical site, logistic regression models were developed to predict the probability of treatment failure. Results: Severity of urge incontinence symptoms (p = 0.041), prolapse stage (p = 0.013), and being postmenopausal without hormone therapy (p = 0.023) were significant predictors for stress failure. Odds of nonstress failure quadrupled for every 10-point increase in Medical, Epidemiological, and Social Aspects of Aging questionnaire urge score (OR 3.93 CI 1.45, 10.65) and decreased more than 2 times for every 10-point increase in stress score (OR 0.36, CI 0.16, 0.84). The associations of risk factors and failure remained similar regardless of surgical group. Conclusions:Two years after surgery, risk factors for stress failure are similar after Burch and sling procedures and include greater baseline urge incontinence symptoms, more advanced prolapse, and menopausal not on hormone replacement therapy. Higher urge scores predicted failure by nonstress specific outcomes. |
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