大型手术队列中合并脱垂和尿失禁的症状。
Symptoms of combined prolapse and urinary incontinence in large surgical cohorts.
机构信息
From the Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois; the Department of Urology, University of Maryland, Baltimore, Maryland; the New England Research Institutes, Watertown, Massachusetts; the Birmingham VA Medical Center and the Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; the Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente, San Diego, California; the Department of Urology, William Beaumont Hospital, Royal Oak, Michigan; the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2010 Feb;115(2 Pt 1):310-316. doi: 10.1097/AOG.0b013e3181cb86b2.
OBJECTIVE
To estimate whether prolapse severity is a major contributor to urinary incontinence severity, as measured by validated incontinence questionnaires.
METHODS
We analyzed data from two large female stress urinary incontinence (SUI) surgical cohorts: the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) study (N=655) and the subsequent Trial of Mid-Urethral Slings (TOMUS) study (N=597). All participants completed a standardized baseline assessment including validated measures of symptom severity, quality of life, objective measures of urine loss (Urogenital Distress Inventory [UDI], Medical, Epidemiologic, and Social Aspects of Aging questionnaire, Incontinence Impact Questionnaire, and pad test), as well as the Pelvic Organ Prolapse Quantification assessment. Groups were compared using the chi; test (categorical measures) or the one-way analysis of variance (continuous measures). Statistical significance was defined as P<.05.
RESULTS
The SISTEr and TOMUS samples were similar for many variables including age (52 and 53 years, respectively), nulliparity (9% and 12%), prior urinary incontinence (UI) surgery (14% and 13%), and prior hysterectomy (31% and 28%), but other differences necessitated separate analysis of the two cohorts. There was not a statistically significant difference in UDI scores according to prolapse stage in either study population. Patients with prior surgery for pelvic organ prolapse and SUI had more incontinence symptoms and were more bothered by their UI regardless of prolapse stage.
CONCLUSION
Prolapse stage is not strongly or consistently associated with incontinence severity in women who select surgical treatment of SUI. Prior pelvic organ prolapse and UI surgery is associated with worse UI severity and bother.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00064662 and NCT00325039.
LEVEL OF EVIDENCE
II.
目的
通过验证的尿失禁问卷来评估脱垂严重程度是否为尿失禁严重程度的主要影响因素。
方法
我们分析了两项大型女性压力性尿失禁（SUI）手术队列的研究数据：压力性尿失禁手术治疗疗效试验（SISTEr）研究（N=655）和随后的经阴道中段吊带术（TOMUS）研究（N=597）。所有参与者均完成了包括症状严重程度、生活质量、尿失禁客观测量（尿失禁困扰量表、尿失禁影响问卷、阴部脱垂严重程度量化评估）以及 Urogenital Distress Inventory（UDI）、Medical、Epidemiologic、and Social Aspects of Aging Questionnaire 等在内的标准化基线评估，且均使用验证过的评估工具。采用卡方检验（分类变量）或单因素方差分析（连续变量）比较各组间的差异。P<.05 定义为差异有统计学意义。
结果
SISTEr 和 TOMUS 样本在年龄（分别为 52 岁和 53 岁）、初产妇（9%和 12%）、既往尿失禁手术史（14%和 13%）和既往子宫切除术（31%和 28%）等方面差异较小，但其他方面的差异使得两个队列需要单独进行分析。在两个研究人群中，UDI 评分与脱垂分期之间均无统计学差异。无论脱垂分期如何，既往盆腔器官脱垂和 SUI 手术患者的尿失禁症状更多，且更受其困扰。
结论
在选择 SUI 手术治疗的女性中，脱垂分期与失禁严重程度无明显关联或相关性不强。既往盆腔器官脱垂和 UI 手术与更严重的 UI 严重程度和困扰有关。
临床试验注册
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00064662 和 NCT00325039。
证据水平
II。
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