Department of Urology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Ann Palliat Med. 2021 Dec;10(12):12589-12597. doi: 10.21037/apm-21-3385.
Patients with pelvic organ prolapse combined with stress urinary incontinence (SUI) require pelvic floor repair and surgical treatment; however, there is currently no systematic evaluation of the treatment effect.
PubMed, Medline, Embase, Elsevier, The Cochrane Library, Web of science, and other databases were searched for randomized controlled trials (RCTs) published between January 2000 and December 2020 regarding tension-free vaginal tape (TVT) treatment of pelvic organ prolapse combined with SUI. Quality evaluation of the articles included in this study was conducted in accordance with the Cochrane Work Manual (5.3), and RevMan 5.3 software was used to conduct meta-analysis of the data extracted from literature meeting the requirements.
A total of 10 articles were included, involving a total of 1,361 subjects, including 553 in the control group (a different surgical treatment) and 808 in the observation group (single TVT or TVT combined with pelvic floor repair). The bias evaluation results showed that all of the included literature was rated as level B, so there was no need for sensitivity analysis. The meta-analysis showed that the combined effect size of the clinical cure rate was {odds ratio (OR) [95% confidence interval (CI)]: 3.82 (1.39, 10.52); Z=2.59, P=0.010}, and the combined effect size of the clinical complication rate was [risk difference (RD) (95% CI): -0.09 (-0.16, -0.02); Z=2.38; P=0.02]. The results showed that the clinical cure rate of the observation group was significantly higher than that of the control group, while the clinical complication rate was significantly lower than that of the control group (P<0.05).
TVT surgery or TVT combined with pelvic floor repair surgery can significantly improve the cure rate of patients with pelvic organ prolapse combined with SUI, and reduce the incidence of postoperative complications. Therefore, TVT is a suitable surgical method for the treatment of patients with pelvic organ prolapse combined with SUI.
盆腔器官脱垂合并压力性尿失禁（SUI）患者需要进行盆底修复和手术治疗；然而，目前尚缺乏对其治疗效果的系统评估。
检索 2000 年 1 月至 2020 年 12 月期间发表的关于经阴道无张力吊带（TVT）治疗盆腔器官脱垂合并 SUI 的随机对照试验（RCT）的 PubMed、Medline、Embase、Elsevier、The Cochrane Library、Web of science 和其他数据库。根据 Cochrane 手册（5.3 版）对纳入研究的文章进行质量评价，并使用 RevMan 5.3 软件对符合要求的文献提取数据进行荟萃分析。
共纳入 10 篇文章，共纳入 1361 例受试者，其中对照组（不同手术治疗）553 例，观察组（单一 TVT 或 TVT 联合盆底修复）808 例。偏倚评价结果显示，所有纳入文献均为 B 级，因此无需进行敏感性分析。荟萃分析显示，临床治愈率的合并效应量为{比值比（OR）[95%置信区间（CI）]：3.82（1.39，10.52）；Z=2.59，P=0.010}，临床并发症发生率的合并效应量为[差异风险（RD）（95%CI）：-0.09（-0.16，-0.02）；Z=2.38；P=0.02]。结果表明，观察组的临床治愈率明显高于对照组，而临床并发症发生率明显低于对照组（P<0.05）。
TVT 手术或 TVT 联合盆底修复手术可显著提高盆腔器官脱垂合并 SUI 患者的治愈率，降低术后并发症发生率。因此，TVT 是治疗盆腔器官脱垂合并 SUI 的一种合适的手术方法。
