Matsuyama H, Tomimatsu T, Tatsumura M, Sugino N, Naito K
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Aktuelle Urol. 2010 Jan;41 Suppl 1:S30-3. doi: 10.1055/s-0029-1224658. Epub 2010 Jan 21.
Scant evidence has been reported on the evaluation of quality-of-life (QOL) in patients who had undergone surgical treatment due to pelvic floor prolapse including cystocele. The aim of this study is to evaluate the impact of surgical intervention on patients' QOL before and after surgery.
Between 1997 and 2007, 135 patients (median age: 66.6 years) with pelvic floor prolapse including cystocele underwent bladder neck suspension with anterior/posterior colporrhaphy. The follow-up period was 39.6 months. Seventy-two patients (53 %) had urinary incontinence. The cystocele was graded as mild (grade 2), moderate (grade 3), and severe (grade 4) in 35, 60, and 40, respectively, according to the Baden-Walker classification. A urodynamic study was performed in 69 patients (51 %) who had obstructive symptoms with 100 ml or more of postvoid residual urine. Postoperative QOL was longitudinally assessed in 114 patients by scoring three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL), and compared with corresponding baseline scores.
A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow-up of 62.2 months. HR-QOL was significantly associated with vitality assessed by SF 36 (p = 0.036). Multivariate analysis revealed that update urinary incontinence, pre-operative HR-QOL was independent prognostic factors for predicting postoperative patient's satisfaction.
Although surgical repair of pelvic floor prolapse can achieve acceptable results with intermediate-term durability as well as improving the QOL, preoperative patients' HR-QOL may be considered in the decision making process for treatment.
关于因盆腔器官脱垂（包括膀胱膨出）接受手术治疗患者的生活质量（QOL）评估，相关报道证据不足。本研究旨在评估手术干预对患者术前和术后生活质量的影响。
1997年至2007年间，135例盆腔器官脱垂（包括膀胱膨出）患者（中位年龄：66.6岁）接受了膀胱颈悬吊术联合前后阴道壁修补术。随访期为39.6个月。72例患者（53%）存在尿失禁。根据巴登-沃克分类法，膀胱膨出分别为轻度（2级）35例、中度（3级）60例和重度（4级）40例。69例（51%）有梗阻症状且排尿后残余尿量100ml或更多的患者进行了尿动力学研究。通过对三个疾病特异性项目（阴道膨出感、梗阻症状、尿失禁）和一个总体健康相关生活质量（HR-QOL）进行评分，对114例患者的术后生活质量进行纵向评估，并与相应的基线评分进行比较。
一项纵向研究表明，在中位随访62.2个月时，这些症状持续显著改善。HR-QOL与SF-36评估的活力显著相关（p = 0.036）。多变量分析显示，新发尿失禁、术前HR-QOL是预测术后患者满意度的独立预后因素。
尽管盆底脱垂的手术修复在中期耐久性方面能取得可接受的结果，并能改善生活质量，但在治疗决策过程中可能应考虑术前患者的HR-QOL。
