Oliphant Sallie S, Shepherd Jonathan P, Lowder Jerry L
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Magee Women's Hospital, Pittsburgh, PA 15213, USA.
Female Pelvic Med Reconstr Surg. 2012 Jul-Aug;18(4):216-20. doi: 10.1097/SPV.0b013e3182604b6b.
The objective of this study was to estimate optimal timing for treatment of occult stress urinary incontinence in women undergoing colpocleisis using decision analysis methodology.
A decision tree was constructed comparing concomitant versus staged midurethral slings (MUSs). Simple roll-back methodology was used to determine average 1-year utilities of the compared approaches.
One-year overall utility favored the staged approach to treating occult incontinence (0.945 vs 0.908) at time of colpocleisis. However, this difference was less than the accepted minimally important difference for utilities. Multiple 1-way sensitivity analyses of all utilities and probabilities identified few thresholds, confirming model robustness. In our model, only 22.5% of women in the staged group ultimately underwent MUS.
Staged and concomitant MUSs have similar overall utilities. Both strategies are clinically reasonable, and surgical decision making should be tailored to individual patient needs and preferences. In our model, a staged approach greatly reduces the number of MUS performed.
本研究的目的是使用决策分析方法估计接受阴道封闭术的女性隐匿性压力性尿失禁的最佳治疗时机。
构建决策树，比较同期与分期的中段尿道吊带术（MUS）。使用简单的回溯方法确定比较方法的平均1年效用值。
在阴道封闭术时，1年总体效用值支持分期治疗隐匿性尿失禁的方法（0.945对0.908）。然而，这种差异小于公认的效用值最小重要差异。对所有效用值和概率进行的多次单向敏感性分析确定了很少的阈值，证实了模型的稳健性。在我们的模型中，分期组中只有22.5%的女性最终接受了MUS。
分期和同期MUS的总体效用值相似。两种策略在临床上都是合理的，手术决策应根据个体患者的需求和偏好进行调整。在我们的模型中，分期方法大大减少了MUS的实施数量。
