Wu Xiaoyu, Berto Fernanda Gabrigna, Welk Blayne
Department of Surgery, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Neurourol Urodyn. 2025 Feb;44(2):267-275. doi: 10.1002/nau.25621. Epub 2024 Nov 6.
Adult patients with neurogenic lower urinary tract dysfunction (NLUTD) often have urinary symptoms that impact their quality of life (QOL). Our objective is to identify and summarize studies evaluating QOL changes across different NLUTD surgical interventions.
A systematic rapid evidence review was carried using EMBASE and MEDLINE. We included adult patients (> 18 years old) with NLUTD who underwent a relevant surgery and had a measurement of QOL. We included pre-post study designs (primary focus) and cross-sectional studies (secondary focus). Studies were reviewed and data extracted by multiple assessors. Standardized data extraction tables were used, and qualitative synthesis was performed.
Of the 1074 screened articles 26 were included. There were 3/15 studies that evaluated reconstructive surgery (augmentation and/or catheterisable channel) pre-post intervention (n = 94 patients); there was a 7%-28% relative improvement in bladder related and overall QOL using validated questionnaires, and a large magnitude of improvement in studies using unvalidated questionnaires. There were 3/7 studies that looked at urinary diversion pre-post intervention (n = 153 patients) and showed an approximately 20%-60% improvement in validated questionnaires assessing bladder specific quality of life, and 0%-25% improvement in overall quality of life. Finally, 3/4 studies were pre-post stress incontinence surgeries (n = 67 patients) and they found an improvement in the ICIQ questionnaire scores and study-specific questionnaires.
The literature supporting a change in QOL in adult NLUTD patients undergoing surgical interventions is extremely limited due to a lack of pre-post studies, and the frequent use of unvalidated outcome measures.
患有神经源性下尿路功能障碍（NLUTD）的成年患者常出现影响其生活质量（QOL）的泌尿系统症状。我们的目的是识别和总结评估不同NLUTD手术干预后生活质量变化的研究。
使用EMBASE和MEDLINE进行系统的快速证据回顾。我们纳入了接受相关手术并进行了生活质量测量的成年NLUTD患者（>18岁）。我们纳入了干预前后研究设计（主要重点）和横断面研究（次要重点）。由多名评估人员对研究进行审查并提取数据。使用标准化的数据提取表，并进行定性综合分析。
在1074篇筛选的文章中，纳入了26篇。有3/15项研究评估了重建手术（扩大和/或可导尿通道）干预前后的情况（n = 94例患者）；使用经过验证的问卷，膀胱相关和总体生活质量相对改善了7%-28%，而使用未经验证问卷的研究改善幅度更大。有3/7项研究观察了尿流改道干预前后的情况（n = 153例患者），在评估膀胱特定生活质量的经过验证的问卷中显示改善约20%-60%，总体生活质量改善0%-25%。最后，3/4项研究是压力性尿失禁手术前后的研究（n = 67例患者），他们发现ICIQ问卷得分和特定研究问卷有所改善。
由于缺乏干预前后研究以及频繁使用未经验证的结局指标，支持成年NLUTD患者手术干预后生活质量发生变化的文献极其有限。
