Bjoersum-Meyer Thomas, Kaalby Lasse, Lund Lars, Christensen Peter, Jakobsen Marianne S, Baatrup Gunnar, Qvist Niels, Ellebaek Mark
Department of Surgery, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Eur Urol Open Sci. 2021 Feb 3;25:29-38. doi: 10.1016/j.euros.2021.01.007. eCollection 2021 Mar.
Long-term urinary and sexual outcomes after repair of anorectal malformations (ARMs) are currently affected by concomitant malformations of the urinary tract and genitalia, sacral anomalies, and the surgical approach. However, the overall prevalence of urinary and sexual dysfunction remains unclear.
To evaluate the prevalence of urinary and sexual dysfunction in patients aged >10 yr after repair of ARM in infancy.
A systematic literature review was performed using the Medline, Embase, and Cochrane databases. Selected studies were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. We included studies reporting the prevalence of the following outcomes: urinary incontinence (UI), lower urinary tract symptoms (LUTS), neurogenic bladder dysfunction (NBD), sexual dysfunction (SD), erectile dysfunction (ED), ejaculatory dysfunction, and birth rate. We initially identified 588 studies, of which 17 were included for evidence synthesis.
A probabilistic meta-analysis on each subgroup revealed the following combined prevalence estimates: UI 16% (95% confidence interval [CI] 7-27%), LUTS/NBD 36% (95% CI 13-62%), SD among women 50% (95% CI 34-66%), ED 12% (95% CI 7-18%), ejaculatory dysfunction 16% (95% CI 9-25%), and birth rate 20% (95% CI 7-38%). Subgroup analysis showed a higher prevalence of ED and ejaculatory dysfunction among patients with high ARM severity when compared to low ARM severity.
Among patients undergoing ARM repair, we found a high prevalence of long-term impairment of UI, ED, and SD. We stress the need for larger multicentre trials with more comparable populations to optimise treatment and follow-up regimens.
We reviewed long-term outcomes for patients with anorectal malformations who underwent surgery and found that both urinary incontinence and sexual dysfunctions are common for both males and females.
目前，肛门直肠畸形（ARM）修复术后的长期泌尿和性功能结局受到尿路和生殖器合并畸形、骶骨异常以及手术方式的影响。然而，泌尿和性功能障碍的总体患病率仍不清楚。
评估婴儿期ARM修复术后10岁以上患者泌尿和性功能障碍的患病率。
使用Medline、Embase和Cochrane数据库进行系统的文献综述。根据报告试验的统一标准（CONSORT）和诊断准确性研究报告标准（STARD）标准对选定的研究进行综述。我们纳入了报告以下结局患病率的研究：尿失禁（UI）、下尿路症状（LUTS）、神经源性膀胱功能障碍（NBD）、性功能障碍（SD）、勃起功能障碍（ED）、射精功能障碍和出生率。我们最初识别出588项研究，其中17项被纳入证据综合分析。
对每个亚组进行的概率性荟萃分析显示了以下合并患病率估计值：UI为16%（95%置信区间[CI]7 - 27%），LUTS/NBD为36%（95% CI 13 - 62%），女性SD为50%（95% CI 34 - 66%），ED为12%（95% CI 7 - 18%），射精功能障碍为16%（95% CI 9 - 25%），出生率为20%（95% CI 7 - 38%）。亚组分析显示，与低ARM严重程度患者相比，高ARM严重程度患者的ED和射精功能障碍患病率更高。
在接受ARM修复的患者中，我们发现UI、ED和SD的长期损害患病率很高。我们强调需要开展更大规模的多中心试验，纳入更具可比性的人群，以优化治疗和随访方案。
我们回顾了接受手术的肛门直肠畸形患者的长期结局，发现尿失禁和性功能障碍在男性和女性中都很常见。
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