压力性尿失禁手术后采用吊带术治疗的女性的生活质量及客观结果评估
Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence.
作者信息
Ulrich Daniela, Bjelic-Radisic Vesna, Höllein Anna, Trutnovsky Gerda, Tamussino Karl, Aigmüller Thomas
机构信息
Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
出版信息
PLoS One. 2017 Mar 27;12(3):e0174628. doi: 10.1371/journal.pone.0174628. eCollection 2017.
BACKGROUND
Midurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision.
METHODS
All patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score.
RESULTS
Tape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9-13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group.
CONCLUSIONS
Women needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates.
背景
中段尿道吊带可能会导致诸如排尿功能障碍、腹股沟疼痛、新发尿急或网片侵蚀等长期并发症，这就需要再次手术。关于接受吊带取出术患者的健康相关生活质量的数据很少。本研究的目的是评估中段尿道吊带切开或切除术后的生活质量（QoL）和客观结果。
方法
邀请1999年至2014年间因排尿困难、疼痛或难治性新发膀胱过度活动症而接受中段尿道吊带切开术的所有患者进行随访。以1:2的比例设立一个未切开尿道下吊带的对照组，并在年龄、使用的吊带和吊带置入年份方面进行匹配。患者完成了国王健康问卷（KHQ）、尿失禁结果问卷、女性性功能指数问卷以及患者总体改善印象评分。
结果
对32名女性进行了吊带切开或切除术。总体而言，25名存活女性中有15名（60%）可接受临床检查并完成问卷。因排尿功能障碍（n = 7）、膀胱过度活动症（n = 2）、网片挤出（n = 3）和持续性疼痛（n = 3）而进行了吊带切开术。吊带切开/切除术的中位时间为10个月。吊带切开组中有3名女性因压力性尿失禁（SUI）接受了再次手术。在中位随访11年（四分位间距9 - 13）时，吊带切开组的主观SUI发生率为53%（8/15名女性），对照组为17%（5/30）（p = 0.016），两组间客观SUI发生率无显著差异。在生活质量方面，与对照组相比，研究组在与SUI相关的领域，即角色限制、身体限制（KHQ）、严重程度测量和社会限制方面的得分明显更差。
结论
与对照组相比，需要进行吊带切开或切除术的女性与SUI相关的QoL得分较低，主要原因是主观SUI发生率较高。
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