Daneshgari Firouz, Moore Courtenay, Frinjari Hassan, Babineau Denise
Glickman Urological Institute and Lerner Research Institute, and Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2006 Oct;176(4 Pt 1):1493-9. doi: 10.1016/j.juro.2006.06.027.
We examined patient related risk factors for recurrent stress urinary incontinence in women treated at a tertiary referral center.
A case-control study was done in 18 to 75-year-old women with signs and symptoms of genuine or mixed stress urinary incontinence and no prior surgical treatment who underwent an open anti-incontinence procedure between 1990 and 2002 at our institution. Cases were defined as patients who underwent more than 1 anti-incontinence surgery and controls were defined as patients who underwent only 1 anti-incontinence procedure with followup during that period. Cases and controls were matched for surgery type, surgeon and date of surgery within 1 year. A total of 47 variables were examined, including patient age, parity, incontinence type, urodynamic findings, medical history (peripheral vascular, pulmonary and cardiac disease), past and concomitant pelvic surgery, social history (alcohol and tobacco use) and body mass index. Univariate conditional logistic regression was done first to determine which variables were potential protective or risk factors. Multivariate conditional logistic regression analysis was then used to determine which factors were statistically significant.
The records of 2,550 women with stress or mixed urinary incontinence who underwent an open surgical procedure between 1990 and 2002 were reviewed. A total of 53 cases and 146 controls were identified. Each case was matched with 1 to 4 controls. Data on cases and controls were collected using a standardized form. At a significance level of 0.05 the possible risk factors for recurrent stress urinary incontinence based on univariate analysis were diabetes mellitus (OR 3.579, p = 0.026), pelvic organ prolapse (OR 5.635, p = 0.03) and concomitant rectocele repair (OR 5.353, p = 0.04). Smoking was marginally protective (OR 0.497, p = 0.068). After multivariate conditional logistic regression analysis diabetes mellitus (adjusted OR 3.413, p = 0.045), pelvic organ prolapse (adjusted OR 8.195, p = 0.021) and concomitant rectocele repair (adjusted OR 17.079, p = 0.012) remained significant risk factors, while smoking remained a protective factor (adjusted OR 0.264, p = 0.012). Body mass index, age, race, parity and estrogen status were not identified as risk factors for recurrent stress urinary incontinence requiring a second anti-incontinence procedure.
In a cohort of women with stress or mixed urinary incontinence treated at our institution between 1990 and 2002 women with diabetes mellitus, pelvic organ prolapse or concomitant rectocele repair were at increased risk for repeat anti-incontinence surgery, while women who smoked were at slightly decreased risk.
我们在一家三级转诊中心对接受治疗的女性复发性压力性尿失禁的患者相关风险因素进行了研究。
对1990年至2002年期间在我们机构接受开放性抗尿失禁手术、年龄在18至75岁、有真性或混合性压力性尿失禁体征和症状且未接受过先前手术治疗的女性进行了一项病例对照研究。病例定义为接受过不止一次抗尿失禁手术的患者，对照定义为在此期间仅接受过一次抗尿失禁手术并进行了随访的患者。病例和对照在手术类型、外科医生和手术日期上在1年内进行匹配。共检查了47个变量，包括患者年龄、产次、尿失禁类型、尿动力学检查结果、病史（外周血管疾病、肺部疾病和心脏病）、既往和同期盆腔手术、社会史（饮酒和吸烟情况）以及体重指数。首先进行单因素条件逻辑回归以确定哪些变量是潜在的保护因素或风险因素。然后使用多因素条件逻辑回归分析来确定哪些因素具有统计学意义。
回顾了1990年至2002年期间接受开放性手术的2550例压力性或混合性尿失禁女性的记录。共识别出53例病例和146例对照。每个病例与1至4例对照进行匹配。使用标准化表格收集病例和对照的数据。在0.05的显著性水平下，基于单因素分析，复发性压力性尿失禁的可能风险因素为糖尿病（OR 3.579，p = 0.026）、盆腔器官脱垂（OR 5.635，p = 0.03）和同期直肠膨出修复（OR 5.353，p = 0.04）。吸烟有轻微的保护作用（OR 0.497，p = 0.068）。经过多因素条件逻辑回归分析，糖尿病（调整后OR 3.413，p = 0.045）、盆腔器官脱垂（调整后OR 8.195，p = 0.021）和同期直肠膨出修复（调整后OR 17.079，p = 0.012）仍然是显著的风险因素，而吸烟仍然是一个保护因素（调整后OR 0.264，p = 0.012）。体重指数、年龄、种族、产次和雌激素状态未被确定为需要进行第二次抗尿失禁手术的复发性压力性尿失禁的风险因素。
在1990年至2002年期间在我们机构接受治疗的压力性或混合性尿失禁女性队列中，患有糖尿病、盆腔器官脱垂或同期直肠膨出修复的女性再次进行抗尿失禁手术的风险增加，而吸烟女性的风险略有降低。
