Kowalski Joseph T, Mehr Allen, Cohen Evan, Bradley Catherine S
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr. PFP OBGYN, Iowa City, IA, 52245, USA.
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Int Urogynecol J. 2018 Nov;29(11):1697-1704. doi: 10.1007/s00192-018-3755-7. Epub 2018 Aug 24.
The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgical success. Understanding which definitions of success have been used and how these may impact reported outcomes is critical. Therefore, we performed a systematic review to identify and summarize these definitions and how they have changed over time.
A PubMed search was performed for studies reporting POP surgical outcomes (1996 and later). Inclusion criteria were: original research, English, adult women with POP, nonobliterative surgical treatment, comparison group, reported prolapse-specific outcomes, and clear definition of treatment success. This definition was categorized according to presence of anatomic, subjective, retreatment, or other components and whether these components were evaluated individually or in a composite definition (in which all components must be present for success).
One-hundred forty articles were included. The number of included studies increased over time (r = 0.90, p < 0.00001). Ninety-five studies (67.9%) reported an anatomic-only definition of success, 43 (30.7%) included a subjective component to their definition of success, and 23 (16.4%) reported a composite definition of success, including 11 (7.9%) containing anatomic, symptomatic, and retreatment components. The most common definition of anatomic success was Pelvic Organ Prolapse Quantification (POP-Q) stage ≤ 1. The report of a significant difference between treatment groups (positive study) was most common in studies using an anatomic-only definition of success (p = 0.037).
The number of comparative studies evaluating POP surgical outcomes has increased from 1996 to 2016. Most use definitions of success based solely on anatomic criteria despite increasing awareness of the importance of reporting subjective outcomes and retreatment rates.
当前关于盆腔器官脱垂（POP）的文献对手术成功采用了大相径庭的定义。了解所使用的成功定义以及这些定义如何影响报告的结果至关重要。因此，我们进行了一项系统综述，以识别和总结这些定义以及它们随时间的变化情况。
在PubMed上搜索报告POP手术结果的研究（1996年及以后）。纳入标准为：原创研究、英文、患有POP的成年女性、非闭塞性手术治疗、对照组、报告脱垂特异性结果以及明确的治疗成功定义。该定义根据解剖学、主观、再次治疗或其他成分的存在情况进行分类，以及这些成分是单独评估还是在综合定义中评估（成功必须具备所有成分）。
纳入了140篇文章。纳入研究的数量随时间增加（r = 0.90，p < 0.00001）。95项研究（67.9%）报告了仅基于解剖学的成功定义，43项（30.7%）在成功定义中纳入了主观成分，23项（16.4%）报告了成功的综合定义，其中11项（7.9%）包含解剖学、症状和再次治疗成分。解剖学成功最常见的定义是盆腔器官脱垂定量（POP-Q）分期≤1。在仅使用解剖学成功定义的研究中，治疗组之间存在显著差异的报告最为常见（p = 0.037）。
从1996年到2016年，评估POP手术结果的比较研究数量有所增加。尽管越来越意识到报告主观结果和再次治疗率的重要性，但大多数研究仍仅基于解剖学标准使用成功定义。
