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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 高育琳 | Normal Preoperative Urodynamic Testing Does Not Predict Voiding Dysfunction After Burch Colposuspension Versus Pubovaginal Sling | 2008/12/29 下午 01:53:23 | 0 |
| 原 文 | 題 目 | Normal Preoperative Urodynamic Testing Does Not Predict Voiding Dysfunction After Burch Colposuspension Versus Pubovaginal Sling |
| 作 者 | Gary E. Lemack, Stephen Krauss, Heather Litman, Mary Pat FitzGerald, Toby Chai, Charles Nager, Larry Sirls, Halina Zyczynski, Jan Baker, Keith Lloyd, W.D. Steers and Urinary Incontinence Treatment Network | |
| 出 處 | The Journal of Urology Vol 180 (5) Pages 2076-2080 | |
| 出版日期 | November 2008, | |
| 評 論 |
尿失禁的手術前的UD檢查，可提供術前的診斷及發現可能影響術後結果的因素。所以幾乎所有尿失禁的病人術前都接受了這個檢查。但是近來的一些研究報告指出，parameters of UD such as leak point pressure它可能無法決定術式的選擇，它可以評估尿失禁的嚴重度，但是它可能無法預估術後的成功率。同樣地detrusor overactivity會造成postoperative urgency or UUI，使醫師在術前評估時，必須告訴病人這個事實，但卻無法術前做一個術式的選擇，以得到滿意的結果。 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 prospective trail，以Burch colposuspension or autologus rectus sling 為治療的術式、追蹤2年的治療結果。在J U 4月份報告了Urodynamic measures do not predict stress continence outcomes after surgery for stress urinary incontinence in ed women 這是他們的第二篇論文探討UD檢查在接受這兩種術式Burch or sling procedure後發生Voiding Dysfunction的角色。 術後的Voiding dysfunction定義為 use of any bladder catheter after 6 weeks, or reoperation for takedown。至於觀察的parameters of UD則是術前的餘尿（PVR)、 最大尿流速，及pressure flow study中最大尿流速時的vesical pressure、abdominal pressure、detrusor pressure。比較術後發生Voiding dysfunction與否的病例，這些parameters的差異是否具有預測的效力。. 在這highly-ed patients group( with dominant stress incontinence, a positive stress test, urethral hypermobility, PVR＜150cc,and bladder capacity＞200cc)，作者似乎呼應了「urodynamics無用論(urodynamics nihilism)」。但是讀者應該小心解讀。 |
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| abstract |
Purpose: Urodynamic studies have been proposed as a means of identifying patients at risk for voiding dysfunction after surgery for stress urinary incontinence. We determined if preoperative urodynamic findings predict postoperative voiding dysfunction after pubovaginal sling or Burch colposuspension. Materials and Methods: Data were analyzed from preoperative, standardized urodynamic studies performed on participants in the Stress Incontinence Treatment Efficacy Trial, in which women with stress urinary incontinence were randomized to undergo pubovaginal sling surgery or Burch colposuspension. Voiding dysfunction was defined as use of any bladder catheter after 6 weeks, or reoperation for takedown of a pubovaginal sling or Burch colposuspension. Urodynamic study parameters examined were post-void residual urine, maximum flow during noninvasive flowmetry, maximum flow during pressure flow study, change in vesical pressure at maximum flow during pressure flow study, change in abdominal pressure at maximum flow during pressure flow study and change in detrusor pressure at maximum flow during pressure flow study. The study excluded women with a preoperative post-void residual urine volume of more than 150 ml or a maximum flow during noninvasive flowmetry of less than 12 ml per second unless advanced pelvic prolapse was also present. Results: Of the 655 women in whom data were analyzed voiding dysfunction developed in 57 including 8 in the Burch colposuspension and 49 in the pubovaginal sling groups. There were 9 patients who could not be categorized and, thus, were excluded from the remainder of the analysis (646). A total of 38 women used a catheter beyond week 6, 3 had a surgical takedown and 16 had both. All 19 women who had surgical takedown were in the pubovaginal sling group. The statistical analysis of urodynamic predictors is based on subsets of the entire cohort, including 579 women with preoperative uroflowmetry, 378 with change in vesical pressure, and 377 with change in abdominal and detrusor pressure values. No preoperative urodynamic study findings were associated with an increased risk of voiding dysfunction in any group. Mean maximum flow during noninvasive flowmetry values were similar among women with voiding dysfunction compared to those without voiding dysfunction in the entire group (23.4 vs 25.7 ml per second, p = 0.16), in the Burch colposuspension group (25.8 vs 25.7 ml per second, p = 0.98) and in the pubovaginal sling group (23.1 vs 25.7 ml per second, p = 0.17). Voiding pressures and degree of abdominal straining were not associated with postoperative voiding dysfunction. Conclusions: In this carefully ed group preoperative urodynamic studies did not predict postoperative voiding dysfunction or the risk of surgical revision in the pubovaginal sling group. Our findings may be limited by the stringent exclusion criteria and studying a group believed to be at greater risk for voiding dysfunction could alter these findings. Additional analysis using subjective measures to define voiding dysfunction is warranted to further determine the ability of urodynamic studies to stratify the risk of postoperative voiding dysfunction, which appears to be limited in the current study. |
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