Nitti V W, Bregg K J, Sussman E M, Raz S
Division of Urology, University of California School of Medicine, Los Angeles.
J Urol. 1993 Apr;149(4):802-7. doi: 10.1016/s0022-5347(17)36212-2.
We reviewed the charts of 92 women 65 years old and older (mean age 72 years, range 65 to 87 years) who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 17 months. Overall, a successful outcome (cure or rare stress urinary incontinence not requiring protection) was achieved in 81 patients (88%). The 2-sample Wilcoxon rank sum test showed that the only predictor of outcome was the subjective degree of preoperative stress urinary incontinence (mild, moderate or severe, p = 0.0148). When the results were stratified by degree of incontinence preoperatively 8 of 8 patients (100%) with mild, 62 of 67 (93%) with moderate and 11 of 17 (65%) with severe incontinence had a successful outcome. Prior hysterectomy, number and type of previous anti-incontinence procedures, and the presence of urgency, urgency incontinence or urodynamic instability were not statistically significant predictors of outcome. In addition, the degree of clinical instability preoperatively had no correlation with the degree of postoperative instability. Of 11 failures 10 occurred within 1 year postoperatively. Significant urgency incontinence was present preoperatively in 32% of the patients with postoperative resolution in 60%. De novo urgency and urgency incontinence occurred in 24% and 13% of the patients, respectively. There was no statistically significant difference in the outcome of surgery in patients 65 years old and older compared to 141 patients less than 65 years old with respect to success, cure of stress urinary incontinence, cure of significant urgency and urgency incontinence, and appearance of de novo instability. The Raz bladder neck suspension is a safe and efficacious treatment for stress incontinence in elderly women. Outcomes can be expected to be the same as in younger women.
我们回顾了1984年1月至1990年6月间因压力性尿失禁接受Raz膀胱颈悬吊术的92名65岁及以上女性（平均年龄72岁，范围65至87岁）的病历。平均随访时间为17个月。总体而言，81名患者（88%）获得了成功的结果（治愈或极少出现压力性尿失禁，无需防护）。两样本Wilcoxon秩和检验显示，结果的唯一预测因素是术前压力性尿失禁的主观程度（轻度、中度或重度，p = 0.0148）。按术前尿失禁程度分层后，轻度尿失禁的8名患者中有8名（100%）、中度尿失禁的67名患者中有62名（93%）、重度尿失禁的17名患者中有11名（65%）获得了成功的结果。既往子宫切除术、既往抗尿失禁手术的次数和类型，以及尿急、急迫性尿失禁或尿动力学不稳定的存在，均不是结果的统计学显著预测因素。此外，术前临床不稳定程度与术后不稳定程度无关。11例失败病例中有10例发生在术后1年内。术前有显著急迫性尿失禁的患者占32%，术后缓解率为60%。新发尿急和急迫性尿失禁分别发生在24%和13%的患者中。与141名65岁以下患者相比，65岁及以上患者在手术成功、压力性尿失禁治愈、显著尿急和急迫性尿失禁治愈以及新发不稳定出现方面的手术结果无统计学显著差异。Raz膀胱颈悬吊术是老年女性压力性尿失禁的一种安全有效的治疗方法。预期结果与年轻女性相同。
