Gabriel Iwona, Tavakkoli Ali, Minassian Vatche A
Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):120-125. doi: 10.1097/SPV.0000000000000505.
The objective of this study was to determine if weight loss surgery is associated with decreased prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms.
A survey was conducted among previously morbidly obese women who underwent bariatric surgery at Brigham and Women's Hospital, Boston from 2007 to 2015. In addition to the Pelvic Floor Distress Inventory 20, we collected demographic and clinical data including symptoms of and treatment for UI and POP before surgery. Participants were divided into 4 quartiles based on self-reported postsurgical weight loss: less than 26.1 kg, 26.1 to 36.2 kg, 36.3 to 46.2 kg, and greater than 46.2 kg. Cox proportional hazard ratios were used to estimate risk of UI and POP by quartile. Kruskal-Wallis test was used to compare bother scores between the groups.
A total of 447 women responded to the survey. Mean follow-up from surgery was 5 years. Women with Roux-en-Y gastric bypass had significantly greater weight loss than gastric banding or sleeve gastrectomy. The adjusted hazard ratios of current UI, stress UI, urgency UI, and prolapse decreased with increasing weight loss quartile (P trend <0.005). Based on the Pelvic Floor Distress Inventory 20, prevalence of POP symptoms was 26% with a mean bother score of 50. Although symptom bother by quartile of weight loss was not statistically significant, the trend (from the first to fourth quartile) for the mean values of Urogenital Distress Inventory 6 (from 13 to 9) and Pelvic Organ Prolapse Distress Inventory 6 (from 26 to 20) showed an improvement in bother symptoms.
There exists an inverse relationship between amount of weight loss and subsequent POP and UI symptoms 5 years after bariatric surgery.
本研究的目的是确定减肥手术是否与尿失禁（UI）和盆腔器官脱垂（POP）症状的患病率降低相关。
对2007年至2015年在波士顿布莱根妇女医院接受减肥手术的既往病态肥胖女性进行了一项调查。除了盆底困扰量表20外，我们还收集了人口统计学和临床数据，包括手术前UI和POP的症状及治疗情况。根据自我报告的术后体重减轻情况，参与者被分为4个四分位数组：小于26.1千克、26.1至36.2千克、36.3至46.2千克和大于46.2千克。使用Cox比例风险比按四分位数估计UI和POP的风险。使用Kruskal-Wallis检验比较各组之间的困扰评分。
共有447名女性回复了调查。手术后的平均随访时间为5年。接受Roux-en-Y胃旁路手术的女性体重减轻明显多于胃束带术或袖状胃切除术。随着体重减轻四分位数的增加，当前UI、压力性UI、急迫性UI和脱垂的调整后风险比降低（P趋势<0.005）。根据盆底困扰量表20，POP症状的患病率为26%，平均困扰评分为50分。虽然按体重减轻四分位数划分的症状困扰在统计学上不显著，但泌尿生殖系统困扰量表6（从13降至9）和盆腔器官脱垂困扰量表6（从26降至20）的平均值趋势（从第一四分位数到第四四分位数）显示困扰症状有所改善。
减肥手术后5年，体重减轻量与随后的POP和UI症状之间存在负相关关系。
