University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
Urolithiasis. 2019 Dec;47(6):575-581. doi: 10.1007/s00240-018-1084-4. Epub 2018 Oct 25.
The objective of the study was to investigate the effect of the menstrual cycle and menopause on extracorporeal shock wave lithotripsy (ESWL)-related pain outcome. Since March 2017, we evaluated a total of 145 women who underwent the first session of ESWL for renal or ureteral stones. Patients were divided into two groups, as menstruating and menopaused women. For menstruating women, the number of days between the last day of mens and ESWL was noted and women were separated as in the follicular phase (1-14 days) or in the luteal phase (15-30 days) of menstruation. To control these two female groups, 149 men of similar age were included in the study. After the procedure, the experienced pain was recorded on a ten-point visual analog scale (VAS) by the patient and they also rated the severity of pain as no, mild, tolerable, and intolerable on the pain questionnaire. The mean age of the patients was 43 ± 15 years for the female group and 42 ± 13 years for the male group. While stone burden was not different between the female and male groups (p = 0.459), VAS score was not statistically different between genders (p = 0.293). However, men reported a higher rate of mild pain, while women reported a higher rate of tolerable pain (p = 0.008) in the pain questionnaire. Mean VAS score was significantly lower for the menopaused women group than menstruating women, young and old men (p = 0.001). In a subgroup analysis, menopaused women group reported lower VAS score and better pain questionnaire result than menstruating women (p < 0.001). There was no statistically significant difference between the follicular and luteal phase of the menstrual cycle in terms of mean VAS score and pain questionnaire results (p = 0.891 and 0.441, respectively). When compared with the young men group, the only significant difference was pain questionnaire results between women in the luteal phase (p = 0.014). Multiple regression analysis showed that only menstruation (β = 0.639, p < 0.001) was an independent factor for VAS score. Menstrual cycle phase had no effect on pain perception during the ESWL session and menopaused women felt less pain than menstruating women during this procedure. The control male group showed that the reduction of ESWL-related pain in menopause was not related to aging.
本研究旨在探讨月经周期和绝经对体外冲击波碎石术（ESWL）相关疼痛结局的影响。自 2017 年 3 月以来，我们共评估了 145 名因肾结石或输尿管结石接受首次 ESWL 治疗的女性患者。患者分为月经期和绝经后两组。对于月经期患者，记录从末次月经到 ESWL 的天数，并根据月经周期的卵泡期（1-14 天）或黄体期（15-30 天）将患者分开。为了控制这两个女性组，我们还纳入了 149 名年龄相似的男性作为对照组。治疗后，患者通过视觉模拟评分法（VAS）在 10 分制上记录疼痛程度，并通过疼痛问卷评估疼痛严重程度，分为无、轻度、可忍受和难以忍受。女性组患者的平均年龄为 43±15 岁，男性组为 42±13 岁。虽然女性组和男性组的结石负荷无统计学差异（p=0.459），但 VAS 评分在性别之间无统计学差异（p=0.293）。然而，男性报告轻度疼痛的比例较高，而女性报告可忍受疼痛的比例较高（p=0.008）。与月经期女性、年轻男性和老年男性相比，绝经后女性组的平均 VAS 评分显著降低（p=0.001）。在亚组分析中，绝经后女性组 VAS 评分和疼痛问卷结果均低于月经期女性（p<0.001）。月经周期的卵泡期和黄体期在 VAS 评分和疼痛问卷结果方面无统计学差异（p=0.891 和 0.441）。与年轻男性组相比，只有黄体期女性的疼痛问卷结果存在统计学差异（p=0.014）。多因素回归分析显示，只有月经周期（β=0.639，p<0.001）是 VAS 评分的独立因素。月经周期阶段对 ESWL 过程中的疼痛感知没有影响，绝经后女性在该过程中感觉疼痛较轻。对照组男性显示，绝经期 ESWL 相关疼痛减轻与年龄无关。
