Lapitan Marie Carmela M, Cody June D, Grant Adrian
National Institute of Health - Philippines, University of the Philippines, Manila 1000, Philippines.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD002912. doi: 10.1002/14651858.CD002912.pub3.
Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure.
To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.
We searched the Cochrane Incontinence Group Specialised Register (searched 30 June 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies.
Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group.
Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated.
This review included 46 trials involving a total of 4738 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower failure rate for subjective cure after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (RR of failure 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond 5 years). In comparison with needle suspensions there was a lower failure rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71), and beyond five years (RR 0.32; 95% CI 15 to 0.71). Evidence from twelve trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up showed no significant difference between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials failure was less common after Burch (RR 0.38 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up time.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures.
AUTHORS' CONCLUSIONS: The evidence available indicates that open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85 to 90%. After five years, approximately 70% of patients can expect to be dry. Newer minimal access procedures like tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of its adverse event profile must be done. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.
尿失禁是一个常见且可能使人衰弱的问题。开放性耻骨后阴道膀胱悬吊术是一种外科治疗方法，该方法涉及在耻骨前方区域提升膀胱颈和近端尿道附近的组织，以纠正尿道闭合不全。
评估开放性耻骨后阴道膀胱悬吊术治疗尿失禁的效果。
我们检索了Cochrane尿失禁组专业注册库（检索时间为2008年6月30日）以及相关文章的参考文献列表。我们联系了研究人员以查找其他研究。
对有压力性或混合性尿失禁症状或尿动力学诊断的女性进行的随机或半随机对照试验，其中至少有一个试验组包括开放性耻骨后阴道膀胱悬吊术。
由两位审阅者对研究的方法学质量/偏倚易感性以及纳入的适宜性进行评估，并提取数据。试验数据按干预措施进行分析。在适当情况下，计算汇总统计量。
本综述纳入了46项试验，共涉及4738名女性。开放性耻骨后阴道膀胱悬吊术的总体治愈率为68.9%至88.0%。两项小型研究表明，与保守治疗相比开放性耻骨后阴道膀胱悬吊术后的失败率更低。同样，一项试验表明，与抗胆碱能治疗相比开放性耻骨后阴道膀胱悬吊术后的失败率更低。六项试验的证据显示，开放性耻骨后阴道膀胱悬吊术后主观治愈的失败率低于前位阴道壁修补术后。这种益处随着时间的推移得以维持（第一年失败的相对危险度为0.51；95%可信区间为0.34至0.76，1至5年时相对危险度为0.43；95%可信区间为0.32至0.57，5年以后相对危险度为0.49；95%可信区间为0.32至0.75）。与穿刺悬吊术相比，阴道膀胱悬吊术后第一年（相对危险度为0.66；95%可信区间为0.42至1.03）、第一年之后（相对危险度为0.48；95%可信区间为0.33至0.71）以及五年之后（相对危险度为0.32；95%可信区间为0.15至0.71）的失败率更低。与尿道下吊带术相比，十二项试验的证据显示在所有评估时间段内失败率均无显著差异。患者报告的短期、中期和长期随访失败率显示，开放性和腹腔镜耻骨后阴道膀胱悬吊术之间无显著差异，但可信区间较宽。在两项试验中，随访1至5年时，Burch手术（相对危险度为0.38，95%可信区间为0.18至0.76）后的失败情况比Marshall Marchetti Krantz手术少见。在任何其他随访时间的数据都很少。总体而言，现有证据并未表明与其他开放性手术技术相比，开放性耻骨后阴道膀胱悬吊术的发病率或并发症发生率更高，尽管盆腔器官脱垂比前位阴道壁修补术和吊带手术后更常见。
现有证据表明，开放性耻骨后阴道膀胱悬吊术是治疗压力性尿失禁的一种有效治疗方式，尤其是从长期来看。在治疗的第一年内，总体控尿率约为85%至90%。五年后，约70%的患者有望实现干爽。与开放性阴道膀胱悬吊术相比，新型的微创方法如无张力阴道吊带看起来很有前景，但其长期性能尚不清楚，必须对其不良事件特征进行更密切的监测。腹腔镜阴道膀胱悬吊术应能使恢复更快，但其相对安全性和有效性尚不清楚。
