女性压力性尿失禁手术治疗后性功能的变化：系统评价和荟萃分析。
Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis.
机构信息
ABC Medical School, Santo André, SP, Brazil.
ABC Medical School, Santo André, SP, Brazil.
出版信息
Sex Med Rev. 2018 Apr;6(2):224-233. doi: 10.1016/j.sxmr.2017.10.005. Epub 2017 Dec 28.
INTRODUCTION
The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner.
AIM
To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function.
METHODS
The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI).
MAIN OUTCOME MEASURES
The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR "standard midurethral slings" OR tensionless vaginal tape* OR mini sling* OR Burch* OR "Burch colposuspension" OR "urologic surgical procedures" OR "tension-free vaginal tape" OR pubovaginal sling) AND (sexual behavior OR "Female Sexual Function Index" OR FSFI OR sexual function OR "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire" OR PISQ-12).
RESULTS
1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI = -2.48 to -2.32; I = 35%, P < .00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant difference (95% CI = -1.77 to 3.78; I = 0%, P = .48).
CONCLUSION
The impact of UI surgery on sexual function is uncertain because of the imprecision of the effect and inconsistency among studies. Only limited evidence on the impact of the transobturator vs the retropubic sling was found. Bicudo-Fürst MC, Borba Leite PH, Araújo Glina FP, et al. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. Sex Med Rev 2018;6:224-233.
介绍
手术治疗压力性尿失禁（SUI）对女性性功能的影响在医学文献中受到关注，但没有以结构化的方式进行评估。
目的
评估最新证据表明女性 SUI 的手术治疗对女性性功能的影响。
方法
对已发表在 Medline、Cochrane、LILACS、SCOPUS、Web of Science、CINHAL 和 EMBASE 中的可用文章进行综述和荟萃分析，这些文章包括评估接受过尿失禁手术治疗的患者的前瞻性随机和非随机研究，使用了 2 种经过验证的问卷：盆腔器官脱垂尿失禁性性功能问卷（PISQ-12）和女性性功能指数（FSFI）。
主要观察指标
搜索了以下术语：（尿失禁 OR 女性 OR 妇女 OR 女人）和（尿道下悬吊带 OR 经闭孔吊带* OR 经闭孔尿道下吊带 OR 经闭孔吊带* OR 尿道吊带* OR 中尿道吊带* OR 中尿道吊带* OR “标准中尿道吊带” OR 无张力阴道吊带* OR 迷你吊带* OR Burch* OR “Burch 耻骨后悬吊术” OR “泌尿科手术” OR “无张力阴道吊带” OR 耻骨阴道吊带）和（性行为 OR “女性性功能指数” OR FSFI OR 性功能 OR “盆腔器官脱垂/尿失禁性性功能问卷” OR PISQ-12）。
结果
共检索到 1043 篇文章，其中 9 项研究进行了定性分析，4 项研究进行了荟萃分析。25 篇文章因使用了 FSFI 和 PISQ-12 以外的问卷而被排除在外。对 2 项包含 411 名接受经耻骨后和经闭孔吊带干预并完成 PISQ-12 问卷的女性的研究进行荟萃分析显示，与经耻骨后吊带干预相比，经闭孔吊带干预后女性性功能增加了 2.40 分（95% CI=-2.48 至-2.32；I=35%，P<0.00001）。然而，另外 2 项比较相同技术但使用 FSFI 的研究包含 183 名女性，并没有显示出统计学上的显著差异（95% CI=-1.77 至 3.78；I=0%，P=0.48）。
结论
由于效应的不精确性和研究之间的不一致性，尿失禁手术对性功能的影响尚不确定。仅发现了经闭孔吊带与耻骨后吊带比较的有限证据。Bicudo-Fürst MC、Borba Leite PH、Araújo Glina FP 等。《压力性尿失禁手术治疗对女性性功能的影响：系统评价和荟萃分析》。性医学评论 2018；6:224-233。
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