Department of Rehabilitation, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, China.
Research and Transformation Center of Intelligent Rehabilitation Assistance Devices, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Arch Gynecol Obstet. 2024 Sep;310(3):1749-1755. doi: 10.1007/s00404-024-07657-1. Epub 2024 Aug 14.
To explore the effectiveness of sling surgery followed by pelvic floor muscle exercises (PFME) or PFME alone for moderate stress urinary incontinence (SUI) in women and its influencing factors.
This is a prospective observational cohort study investigating whether sling surgery or PFME is preferred for pre-menopause women with moderate uncomplicated SUI. Those who received PFME alone or sling surgery were divided to PT or TVT group, respectively. The primary outcome was objective cure at 12 months. The secondary outcomes included Incontinence Impact Questionnaire-Short Form (IIQ-7) scores and PFME adherence.
The study sample comprised 130 and 74 patients in the PT and TVT groups, respectively. There was 38.2% of patients adhered to PFME twice weekly or more often, and the compliance varied by education level. At 12 months, the objective cure rate was significantly higher in the TVT versus PT group (75.7% vs 47.7%; adjusted OR = 4.27; 95% CI, 2.05-8.87; P < 0.001). In addition, the mean reduction in IIQ-7 scores was greater in the TVT group (16.2 vs 10.0; adjusted OR = 3.38; 95% CI, 1.93-4.82; P < 0.001). However, among patients with lower education or those without adherence to PFME at 12 months, the TVT was also favorized, and the discrepancy in cure rates was greater between the two groups.
Sling procedures followed by PFME demonstrate greater efficacy versus physiotherapy alone for moderate female SUI management. Continued adherence to PFME was important, even for patients undergoing sling procedures. Educational factors influenced patient PFME adherence and the advantage conferred by sling procedures.
探讨吊带手术联合盆底肌锻炼（PFME）或单独 PFME 治疗女性中度压力性尿失禁（SUI）的效果及其影响因素。
这是一项前瞻性观察性队列研究，旨在探讨吊带手术或 PFME 治疗围绝经期女性中度单纯性 SUI 的效果。单独接受 PFME 或吊带手术的患者分别分为 PT 或 TVT 组。主要结局为 12 个月时的客观治愈率。次要结局包括尿失禁影响问卷-短表（IIQ-7）评分和 PFME 依从性。
PT 和 TVT 组分别纳入 130 例和 74 例患者。有 38.2%的患者每周坚持进行 2 次或以上的 PFME，且依从性因教育程度而异。12 个月时，TVT 组的客观治愈率显著高于 PT 组（75.7%比 47.7%；调整 OR=4.27；95%CI，2.05-8.87；P<0.001）。此外，TVT 组 IIQ-7 评分的平均降低幅度更大（16.2 比 10.0；调整 OR=3.38；95%CI，1.93-4.82；P<0.001）。然而，在教育程度较低或 12 个月时未坚持进行 PFME 的患者中，TVT 也更具优势，且两组之间的治愈率差异更大。
吊带手术联合 PFME 治疗女性中度 SUI 的效果优于单纯物理治疗。坚持进行 PFME 非常重要，即使是接受吊带手术的患者也是如此。教育因素影响患者对 PFME 的依从性，以及吊带手术的优势。
