Luz Rita, Pereira Inês, Henriques Alexandra, Ribeirinho Ana Luísa, Valentim-Lourenço Alexandre
Department of Obstetrics and Gynecology, Centro Hospitalar de Setúbal, Setubal, Portugal.
, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal.
Int Urogynecol J. 2017 Jan;28(1):139-145. doi: 10.1007/s00192-016-3089-2. Epub 2016 Jul 16.
Midurethral slings (MUS) are the mainstay of treatment for stress urinary incontinence, but the definition of success varies widely amongst studies. The King's Health Questionnaire (KHQ) was designed to evaluate the impact of urinary incontinence on the quality of life. We hypothesised that the KHQ could be useful for postoperative quantitative assessment of subjective outcomes.
This is a retrospective analysis of 204 patients who underwent incontinence surgery with transobturator MUS between 2004 and 2013. Follow-up was planned at 6, 12 and 24 months and success was evaluated using the cough stress test (objective cure) and the KHQ global score (subjective outcomes). Statistical analysis included receiver operating characteristic (ROC) curves to calculate a cut-off value for the KHQ global score to define subjective cure. The minimal clinically important difference was calculated with a distribution-based method (effect size) to estimate subjective improvement.
Objective cure rates were 97 % and 95 % at 6 and 24 months respectively. ROC curves established the cut-off score at ≤ 31 for subjective cure, with sensitivity of 63-100 % and specificity of 82-88 %. Subjective cure rates were 80 % and 85 % at 6 and 24 months respectively. The minimal clinically important difference was set at 10 and an improvement of ≥ 10 points was defined as subjective improvement. Rates varied between 10 and 13 %.
This study showed the value of the KHQ as an evaluation tool after UI surgery and determined clinically relevant threshold scores to define subjective outcomes.
中段尿道吊带术（MUS）是压力性尿失禁治疗的主要方法，但各研究中成功的定义差异很大。国王健康问卷（KHQ）旨在评估尿失禁对生活质量的影响。我们假设KHQ可用于术后主观结果的定量评估。
这是一项对2004年至2013年间接受经闭孔MUS尿失禁手术的204例患者的回顾性分析。计划在6、12和24个月进行随访，并使用咳嗽压力试验（客观治愈）和KHQ全球评分（主观结果）评估成功率。统计分析包括绘制受试者工作特征（ROC）曲线，以计算KHQ全球评分的临界值来定义主观治愈。采用基于分布的方法（效应量）计算最小临床重要差异，以评估主观改善情况。
6个月和24个月时的客观治愈率分别为97%和95%。ROC曲线确定主观治愈的临界评分为≤31分，敏感性为63%-100%，特异性为82%-88%。6个月和24个月时的主观治愈率分别为80%和85%。最小临床重要差异设定为10分，≥10分的改善定义为主观改善。改善率在10%至13%之间。
本研究显示了KHQ作为尿失禁手术后评估工具的价值，并确定了定义主观结果的临床相关阈值评分。
