Leshem Avner, Groutz Asnat, Amir Hadar, Gordon David, Shimonov Mordechai
a Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine , Lis Maternity and Women's Hospital, Tel Aviv University , Tel Aviv , Israel.
b E. Wolfson Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
Scand J Urol. 2018 Jun;52(3):219-224. doi: 10.1080/21681805.2018.1447600. Epub 2018 Mar 13.
The aim of this study was to evaluate the effect over time of bariatric surgery on female pelvic floor symptoms.
In total, 160 consecutive adult women were requested to complete four anonymous questionnaires [International Consultation on Incontinence Questionnaire (ICIQ), Bristol Female Lower Urinary Tract Symptoms (BFLUTS), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] before bariatric surgery and at 3-6 months and 12-24 months postoperatively. Strict criteria were used to define clinically significant urinary incontinence (UI), pelvic organ prolapse (POP) and colorectal-anal (CRA) symptoms. Statistical analyses were performed using paired, two-sided, Student's t test for continuous data, and Fisher's exact test for categorical data.
Altogether, 101 women (67%, mean age 41.6 ± 11.8 years, mean preoperative body mass index 41.6 ± 4.6 kg/m²) completed all questionnaires. In women who had preoperative UI (42.6%), mean ICIQ score decreased from 9.5 ± 4.0 at baseline to 3.0 ± 3.6 (p < .001) and 2.9 ± 3.9 (p < .001) at 3-6 and 12-24 months postoperatively, respectively. In women who had preoperative POP symptoms (17.8%), mean PFDI-20/POP score decreased from 23.8 ± 10.9 at baseline to 12.7 ± 12.9 (p = .010) and 13.7 ± 17.1 (p = .025) at 3-6 and 12-24 months postoperatively. In women who had preoperative CRA symptoms (35.6%), mean PFDI-20/CRA score decreased from 26.0 ± 14.9 at baseline to 15.4 ± 15.1 (p = .001) and 18.8 ± 15.4 (p = .045) at 3-6 and 12-24 months postoperatively. De novo postoperative POP and CRA symptoms were reported by up to 16% of patients.
Surgically induced weight loss is associated with significant improvements in UI, POP and CRA symptoms. The maximal clinical effect was achieved within 3-6 months, and remained constant throughout the second postoperative year. Nevertheless, de novo POP and CRA symptoms are expected in up to 16% of patients.
本研究旨在评估减肥手术对女性盆底症状随时间的影响。
总共160名成年女性被要求在减肥手术前、术后3 - 6个月和12 - 24个月完成四份匿名问卷[国际尿失禁咨询问卷（ICIQ）、布里斯托尔女性下尿路症状问卷（BFLUTS）、盆底困扰量表（PFDI - 20）和盆腔器官脱垂/尿失禁性功能问卷（PISQ - 12）]。采用严格标准定义具有临床意义的尿失禁（UI）、盆腔器官脱垂（POP）和结直肠 - 肛门（CRA）症状。对连续数据使用配对双侧学生t检验进行统计分析，对分类数据使用Fisher精确检验进行统计分析。
共有101名女性（67%，平均年龄41.6±11.8岁，术前平均体重指数41.6±4.6kg/m²）完成了所有问卷。术前有UI的女性（42.6%），ICIQ平均得分从基线时的9.5±4.0分别降至术后3 - 6个月时的3.0±3.6（p <.001）和12 - 24个月时的2.9±3.9（p <.001）。术前有POP症状的女性（17.8%），PFDI - 20/POP平均得分从基线时的23.8±10.9分别降至术后3 - 6个月时的12.7±12.9（p = 0.010）和12 - 24个月时的13.7±17.1（p = 0.025）。术前有CRA症状的女性（35.6%），PFDI - 20/CRA平均得分从基线时的26.0±14.9分别降至术后3 - 6个月时的15.4±15.1（p = 0.001）和12 - 24个月时的18.8±15.4（p = 0.045）。高达16%的患者报告了术后新发的POP和CRA症状。
手术引起的体重减轻与UI、POP和CRA症状的显著改善相关。最大临床效果在3 - 6个月内实现，并在术后第二年保持稳定。然而，预计高达16%的患者会出现新发的POP和CRA症状。
