University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, Birmingham, Alabama.
University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama.
Neurourol Urodyn. 2018 Nov;37(8):2860-2866. doi: 10.1002/nau.23803. Epub 2018 Aug 31.
To compare surgical success rates in older versus younger women a minimum of 3 years post transvaginal native tissue repair for apical prolapse. Post-operative symptom severity and quality of life improvement, surgical complications and retreatment were also examined.
Women who underwent transvaginal native tissue repair for apical prolapse between 2011 and 2013 were eligible. Subjects completed the pelvic floor distress inventory (PFDI-20), pelvic floor impact questionnaire (PFIQ-7), and patient global impression of improvement (PGI-I), and were categorized as "younger" (age <70) or "older" (age ≥70). The primary outcome of surgical success was defined as the absence of bulge symptoms and no re-treatment for prolapse.
Of 641 eligible patients, response rate was 51.0%. 62.7% of subjects had hysterectomy prior to index surgery. Surgical success was noted in 72.9% of younger and 82.2% of older subjects (Adjusted odds ratio [aOR] 1.72, 95% CI [0.93, 3.17]). Older women had greater improvement from baseline in PFDI-20 score (-87.5 [IQR 74.0] vs -54.2 [IQR 80.2], P = 0.01). Retreatment rate and surgical complication rates were similar between groups (both P > 0.05).
Older and younger women had similar surgical success rates a minimum of 3 years post-operative; however, older women had a greater overall symptom severity improvement. This information may be helpful in counseling older women regarding surgical expectations and decision-making.
比较经阴道固有组织修复术后至少 3 年的老年与年轻女性在治疗阴道顶端脱垂方面的手术成功率。还检查了术后症状严重程度和生活质量改善、手术并发症和再次治疗情况。
2011 年至 2013 年期间，接受经阴道固有组织修复术治疗阴道顶端脱垂的女性符合入选标准。研究对象完成了盆底疾病困扰量表（PFDI-20）、盆底影响问卷（PFIQ-7）和患者整体改善印象（PGI-I）的评估，并分为“年轻”（年龄＜70 岁）或“年老”（年龄≥70 岁）组。手术成功的主要结局定义为无膨出症状和无需再次治疗脱垂。
在 641 名符合条件的患者中，应答率为 51.0%。62.7%的患者在指数手术前接受了子宫切除术。年轻组中 72.9%和老年组中 82.2%的患者手术成功（调整后的优势比[aOR]为 1.72，95%CI[0.93，3.17]）。与年轻组相比，老年组的 PFDI-20 评分基线改善更大（-87.5[IQR 74.0] vs -54.2[IQR 80.2]，P=0.01）。两组的再次治疗率和手术并发症发生率相似（均 P＞0.05）。
至少 3 年术后，老年和年轻女性的手术成功率相似；然而，老年女性的整体症状严重程度改善更大。这些信息可能有助于为老年女性提供关于手术预期和决策的咨询。
