Okumura Keiko, Yamaguchi Kumiko, Tamaki Tatsuya, Oinuma Kazuhiro, Tomoe Hikaru, Akita Keiichi
Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Urology, Tosei General Hospital, Aichi, Japan.
Int Urogynecol J. 2017 Apr;28(4):561-568. doi: 10.1007/s00192-016-3138-x. Epub 2016 Sep 16.
Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome.
Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM).
Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients.
Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI.
一些髋关节骨关节炎患者报告称，全髋关节置换术（THA）后尿失禁（UI）情况有所改善。然而，UI的类型和严重程度仍不明确。在本研究中，我们假设压力性尿失禁（SUI）和急迫性尿失禁（UUI）在THA后均会得到改善。我们评估UI的特征，并讨论与UI和THA相关的解剖学因素，以改善治疗效果。
对50例接受直接前路THA的UI患者进行评估。使用四份问卷评估UI类型：下尿路症状核心评分（CLSS）、泌尿生殖系统困扰量表简表（UDI-6）、国际前列腺症状评分（IPSS）和膀胱过度活动症症状评分（OABSS）。使用超声技术测量尿流率和排尿后残余尿量。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和活动范围（ROM）评估髋关节功能。
50例患者中，21例为SUI，16例为混合性尿失禁（MUI），8例为急迫性尿失禁（UUI）。总体而言，36例患者病情好转（72%）。SUI的治愈和改善率为76%，MUI为100%，UUI为50%。治愈或改善的患者ROM改善比病情稳定或恶化的患者更显著。
轻度UI的改善可能是髋关节疾病患者接受THA的额外益处。这些数据表明，对于髋关节疾病患者而言，髋关节治疗可能也对UI有效。
