Abdel-Fattah Mohamed, Cao Gabriel, Mostafa Alyaa
Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
University of Aberdeen, Aberdeen, Scotland.
Neurourol Urodyn. 2017 Apr;36(4):902-908. doi: 10.1002/nau.23192. Epub 2016 Dec 28.
To assess the long-term patient reported outcomes following transobturator tension-free vaginal tapes (TO-TVT) in women with urodynamic mixed urinary incontinence (MUI).
A secondary analysis of the 9-year follow-up of the E-TOT study: 341 women with predominant stress urinary incontinence symptoms were randomized to undergo either inside-out or outside-in TO-TVT between April 2005 and April 2007. Forty-eight women had preoperative urodynamic MUI and were available for 9-year follow-up. Primary outcome was the patient-reported success rate defined as very/much improved on Patient's Global Impression of Improvement PGI-I. Secondary outcomes included impact on women's quality of life, sexual function, overactive bladder symptoms,and late adverse events. Statistical analysis was performed using SPSS v.23.
Forty-eight women completed the 9-year follow-up, with adjusted response rate of 63%. The success based on the PGI-I was 64.6% (n = 31), with a further 14.6% (n = 7) who reported "improved." There was no significant difference between groups (OR 1.11; 95%CI 0.33, 3.70; P > 0.999). Clinically significant improvement in quality of life was found in 85.3%. Cure of urgency and UUI was reported by 35% and 41%, whereas worsening was reported in 6.5% and 2.3%, respectively. One patient reported chronic groin/leg pain. The small sample size and the sizeable loss to follow-up are limitations in this study.
This is the first study to report the long-term outcomes of TO-TVT in women with urodynamic MUI; TO-TVT is associated with a good and sustained patient-reported success rate in women with MUI up to 9-years follow-up.
评估尿动力学混合型尿失禁（MUI）女性患者经闭孔无张力阴道吊带术（TO-TVT）后的长期患者报告结局。
对E-TOT研究的9年随访进行二次分析：2005年4月至2007年4月期间，341名以压力性尿失禁症状为主的女性被随机分为行由内向外或由外向内的TO-TVT。48名女性术前存在尿动力学MUI且可进行9年随访。主要结局是患者报告的成功率，定义为患者整体改善印象量表（PGI-I）上为非常/明显改善。次要结局包括对女性生活质量、性功能、膀胱过度活动症症状及晚期不良事件的影响。使用SPSS v.23进行统计分析。
48名女性完成了9年随访，校正后的应答率为63%。基于PGI-I的成功率为64.6%（n = 31），另有14.6%（n = 7）报告“改善”。两组间无显著差异（OR 1.11；95%CI 0.33，3.70；P > 0.999）。85.3%的患者生活质量有临床显著改善。尿急和急迫性尿失禁的治愈率分别为35%和41%，而分别有6.5%和2.3%的患者报告症状恶化。1名患者报告有慢性腹股沟/腿部疼痛。本研究的局限性在于样本量小及随访失访率高。
这是第一项报告尿动力学MUI女性患者TO-TVT长期结局的研究；在长达9年的随访中，TO-TVT与MUI女性患者良好且持续的患者报告成功率相关。
