Salonia Andrea, Briganti Alberto, Dehò Federico, Zanni Giuseppe, Rigatti Patrizo, Montorsi Francesco
Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
Eur Urol. 2006 Jul;50(1):44-52. doi: 10.1016/j.eururo.2006.03.039. Epub 2006 Mar 31.
To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health.
We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data.
Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health.
Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.
评估泌尿外科妇科手术治疗压力性尿失禁、肿瘤盆腔手术及子宫切除术对女性整体性功能健康的影响。
我们利用Ovid和PubMed（2006年1月更新）在MEDLINE上进行文献电子检索，检索范围包括经同行评审的英文文章。我们分析了所有已确定的研究，这些研究提供了有关泌尿外科妇科手术治疗压力性尿失禁、膀胱癌根治性膀胱切除术、直肠癌手术及子宫切除术的任何功能结局数据。由于病例研究中结局测量和随访间隔存在很大异质性，我们未对数据应用荟萃分析技术。
大多数研究表明，泌尿外科妇科手术或肿瘤盆腔手术可能对女性性功能健康有重大影响。各研究中的流行病学情况差异很大，由于定义、研究设计和患者队列较小，报告的术后性功能要么改善要么受损。越来越多的研究对这一问题进行了前瞻性研究，并且在盆腔和会阴手术在女性性功能健康中的作用方面经常发现有争议的结果。
尽管存在众多争议，但数据表明压力性尿失禁手术修复对性交失禁的解决有总体积极影响，同时改善了整体性生活。相比之下，泌尿生殖系统和直肠癌通常与治疗相关的性功能障碍有关，但很少有研究严格评估大型肿瘤盆腔手术后女性的术后性功能。子宫切除术后功能结局的数据往往相互矛盾。需要有足够样本量的前瞻性临床试验。
