Korman H J, Sirls L T, Kirkemo A K
Department of Urology, Henry Ford Hospital, Detroit, Michigan 48202.
J Urol. 1994 Nov;152(5 Pt 1):1453-7. doi: 10.1016/s0022-5347(17)32443-6.
The reported success rates of the modified Pereyra bladder neck suspension vary from 51 to 90%. Retrospective chart review studies have reported cure rates of 77 to 90%. In contrast, a questionnaire based outcomes analysis, using a strict definition of cure, reported 51% of the patients to be cured of stress urinary incontinence after modified Pereyra bladder neck suspension. We conducted a questionnaire based outcomes analysis of the modified Pereyra bladder neck suspension at our institution. The objectives of the study were to determine the success rates of this procedure using strict criteria in an outcomes analysis format, assess the overall satisfaction of patients postoperatively and identify historical factors that may be predictive of outcome. Between September 1988 and December 1991, 151 patients underwent a modified Pereyra bladder neck suspension for urodynamically documented genuine stress urinary incontinence. Mean patient age was 56 years (range 19 to 82 years) and mean followup was 25 months (range 9 to 45). All patients had type 2 incontinence (anatomical) based on history (severity of symptoms), physical examination, and fluoroscopic assessment of the bladder neck and urethra. Preoperative pad use, and irritative and obstructive symptoms were retrospectively assessed, and a preoperative Stamey incontinence score was assigned. A standardized questionnaire was used to compare preoperative and postoperative voiding symptoms, perception of urinary control and satisfaction with the decision to undergo an operation. Followup telephone calls were made by a trained registered nurse not associated with the original procedure. Postoperative pad use also was quantified and a postoperative Stamey score was assigned. A total of 106 patients (70%) returned the questionnaires. Cure was strictly defined as no urine leakage under any circumstance. While 78% of the patients required no to minimal protection postoperatively, 50 (47%) reported cure of the stress urinary incontinence, 68 (64%) reported subjective improvement, 27 (26%) were the same and 11 (10%) were subjectively worse after modified Pereyra bladder neck suspension. Of the patients 77% were satisfied with the decision to undergo the operation. Patients subjectively worse were significantly older than those subjectively improved (66 versus 54 years, p = 0.05). Postoperative failures had significantly higher obstructive and irritative symptom scores. Questionnaire based outcomes analysis has consistently demonstrated success rates less than those reported in retrospective chart review studies. Outcomes analysis, based on patient assessment of satisfaction, may more accurately reflect the expected surgical outcome after a modified Pereyra bladder neck suspension. We emphasize the need for standardized questionnaires and outcomes analysis to evaluate patient satisfaction with surgery designed to improve quality of life.
改良佩雷拉膀胱颈悬吊术报告的成功率在51%至90%之间。回顾性病历审查研究报告的治愈率为77%至90%。相比之下，一项基于问卷调查的结果分析，采用严格的治愈定义，报告称改良佩雷拉膀胱颈悬吊术后51%的压力性尿失禁患者得到治愈。我们在本机构对改良佩雷拉膀胱颈悬吊术进行了基于问卷调查的结果分析。本研究的目的是采用严格标准，以结果分析的形式确定该手术的成功率，评估患者术后的总体满意度，并确定可能预测结果的历史因素。1988年9月至1991年12月期间，151例患者因尿动力学证实的真性压力性尿失禁接受了改良佩雷拉膀胱颈悬吊术。患者平均年龄为56岁（范围19至82岁），平均随访时间为25个月（范围9至45个月）。根据病史（症状严重程度）、体格检查以及膀胱颈和尿道的荧光镜评估，所有患者均为2型尿失禁（解剖性）。回顾性评估术前使用护垫情况以及刺激性和梗阻性症状，并给出术前斯坦梅尿失禁评分。使用标准化问卷比较术前和术后的排尿症状、尿控感知以及对接受手术决定的满意度。由一名未参与原手术的经过培训的注册护士进行随访电话。对术后使用护垫情况也进行了量化，并给出术后斯坦梅评分。共有106例患者（70%）返回了问卷。治愈被严格定义为在任何情况下均无尿液漏出。虽然78%的患者术后无需或仅需极少的防护，但50例（47%）报告压力性尿失禁已治愈，68例（64%）报告主观上有改善，27例（26%）情况相同，11例（10%）在改良佩雷拉膀胱颈悬吊术后主观上变差。77%的患者对接受手术的决定感到满意。主观上变差的患者明显比主观上有改善的患者年龄大（66岁对54岁，p = 0.05）。术后失败的患者梗阻性和刺激性症状评分明显更高。基于问卷调查的结果分析一直显示成功率低于回顾性病历审查研究报告的成功率。基于患者满意度评估的结果分析可能更准确地反映改良佩雷拉膀胱颈悬吊术后预期的手术效果。我们强调需要标准化问卷和结果分析来评估患者对旨在改善生活质量的手术的满意度。
