Tincello Douglas G, Armstrong Natalie, Hilton Paul, Buckley Brian, Mayne Christopher
Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK.
University Hospitals of Leicester NHS Trust, Leicester, UK.
Int Urogynecol J. 2018 Jan;29(1):45-54. doi: 10.1007/s00192-017-3376-6. Epub 2017 Jun 2.
The objectives were to explore the views of women with recurrent stress incontinence (SUI) with regard to treatment preferences and the acceptability of randomisation to a future trial, and to survey the views of UK specialists on treatment preferences and equipoise regarding different treatment alternatives.
An online survey of the British Society of Urogynaecology (BSUG) and British Society of Urological Surgeons (BAUS) was carried out. Qualitative semi-structured interviews with a purposive sample of surgeons and women suffering from recurrent SUI from three UK centres.
Two hundred fifty-six survey replies were received (176 gynaecology; 80 urology). Comparing the treatments offered, urogynaecologists were more likely to offer pelvic floor exercises (p < 0.05), and repeat midurethral tape (MUT) (p < 0.001). From the Surgical Equipoise Scale (SES) responses, "no preference" was rarely the commonest response. Marked differences for several options existed; midurethral tape dominated responses whenever it appeared. Twenty-one clinicians were interviewed. Treatment preferences were complex, influenced by a range of factors (reason for failure, patient comorbidity, investigations, personal experience, training). A future trial was regarded as important. Eleven women were interviewed. Most had considered more than one option, but felt that decision-making was more a process of elimination rather than a positive process. Randomisation to a study was regarded as unacceptable by most.
No consensus exists among surgeons about preferred treatment options for recurrent SUI, and personal experience and training dominate decision-making. For patients, choices were usually based on an elimination of options, including that of a repeat failed procedure. This contrasts with surgeons, who mostly preferred a repeat MUT above other options. Any future comparative study will be challenging.
本研究旨在探讨复发性压力性尿失禁（SUI）女性对于治疗偏好以及未来试验随机分组可接受性的看法，并调查英国专家对于不同治疗方案的治疗偏好和 equipoise。
对英国妇科学会（BSUG）和英国泌尿外科医师学会（BAUS）进行了在线调查。对来自英国三个中心的外科医生和复发性 SUI 女性进行了定性半结构化访谈。
共收到 256 份调查问卷回复（176 份来自妇科；80 份来自泌尿外科）。比较所提供的治疗方法，妇科泌尿医生更倾向于提供盆底肌锻炼（p < 0.05）和重复中段尿道吊带术（MUT）（p < 0.001）。根据手术 equipoise 量表（SES）的回复，“无偏好”很少是最常见的回复。几个选项存在显著差异；中段尿道吊带术在出现的任何时候都主导着回复。采访了 21 名临床医生。治疗偏好很复杂，受到一系列因素的影响（失败原因、患者合并症、检查、个人经验、培训）。未来的试验被认为很重要。采访了 11 名女性。大多数人考虑了不止一种选择，但觉得决策更多是一个排除过程而非积极过程。大多数人认为随机分组参加研究是不可接受的。
外科医生对于复发性 SUI 的首选治疗方案不存在共识，个人经验和培训主导决策。对于患者来说，选择通常基于排除选项，包括重复失败手术的选项。这与外科医生不同，外科医生大多比其他选项更倾向于重复 MUT。任何未来的比较研究都将具有挑战性。
