Kondo A, Yamada Y, Morishige R, Niijima R
Department of Urology, Nagoya University School of Medicine.
Hinyokika Kiyo. 1996 Nov;42(11):853-9.
Pelvic floor muscle exercises for the treatment of stress urinary incontinence were reported 45 years ago. However, few studies have been made on the long-term outcome and clinical effects in elderly people. We put 123 incontinent women on an intensive exercise programme for 8 weeks and followed them for more than 12 months; 15 patients were over 65 years old and 108 under 65 years old. Self-reported success rates, i.e., cure or a reduction of > 50% of the original severity, were prospectively assessed in the 2 groups immediately and a mean of 28 months (12-52) after the training. Predictive parameters for an immediate and a long-term success were assessed. The intensive programme depended on patients being motivated, patient education, correct muscle contractions, and the keeping of treatment diaries for 8 weeks. Urine loss evaluated objectively and bothersome scores in 6 activities assessed subjectively improved only in the younger adult group. However, vaginal contractile strength increased in both groups. The immediate success rate was 20% and 40% for the elderly and the adults, respectively. Twenty eight months later, the success rate was 27% for the aged and 40% for the adults with 6 patients becoming continent by surgery. Both the short- and long-term success rates were similar in the 2 groups (p < 0.05). 95% of the patients stated that the intensive training was valuable and that they would recommend the training to friends suffering from stress incontinence. Contractile strength of the vagina can be used to predict the immediate treatment outcome, but there are no parameters for predicting the long-term success. In conclusion, the intensive programme of pelvic floor muscle exercises is an effective treatment option for not only for the young adults but also for elderly people suffering from stress incontinence.
45年前就有关于盆底肌肉锻炼治疗压力性尿失禁的报道。然而，针对老年人的长期疗效和临床效果的研究却很少。我们让123名尿失禁女性参加了为期8周的强化锻炼计划，并对她们进行了超过12个月的跟踪；其中15名患者年龄超过65岁，108名患者年龄在65岁以下。前瞻性地评估了两组患者在训练后即刻以及平均28个月（12 - 52个月）后的自我报告成功率，即治愈或症状严重程度减轻超过50%。评估了即刻成功和长期成功的预测参数。强化计划依赖于患者的积极性、患者教育、正确的肌肉收缩以及8周的治疗日记记录。客观评估的尿量减少以及主观评估的6项活动中的困扰评分仅在年轻成年组有所改善。然而，两组的阴道收缩力均有所增加。老年人和成年人的即刻成功率分别为20%和40%。28个月后，老年人的成功率为27%，成年人的成功率为40%，有6名患者通过手术实现了尿失禁治愈。两组的短期和长期成功率相似（p < 0.05）。95%的患者表示强化训练很有价值，并会向患有压力性尿失禁的朋友推荐该训练。阴道收缩力可用于预测即刻治疗效果，但尚无预测长期成功的参数。总之，盆底肌肉锻炼的强化计划不仅是年轻成年人，也是患有压力性尿失禁的老年人的一种有效治疗选择。
