尿道中段吊带对于压力型尿失禁有帮助


  【24drs.com】根据在线发表于7月1日考科蓝实证医学资料库的一篇系统性回顾,尿道中段吊带(Midurethral sling)手术对于压力型尿失禁妇女相当安全,短期与中期的效果也不错。
  
  不过,这个吊带植入物是由手工制造的不可吸收塑料网带,因此可以解释术后疼痛与受伤的报告。虽然证据也显示有长期效果,当考量吊带手术时,必须衡量并发症以及重复手术的长期需求等差异。
  
  另一个考量是利用耻骨后的路径,带子通过耻骨后面并经由腹部离开,或者是经闭孔路径,带子是以边对边通过,经由腹股沟离开。
  
  第一作者、英国Bradford皇家医院的Abigail A. Ford医师在新闻稿中表示,这是相当重要的回顾研究,让妇女们知道,有微创性手术可以治疗这个令人感到虚弱的状况;它提供妇女更多信息,而有助于做出明智选择。
  
  不过,Ford医师提醒妇女,考虑任何类型的手术之前,可以尝试比较无侵犯性的替代方法,如骨盆底(凯格尔)运动。因为每种手术都有一些风险,妇女们须仔细衡量目前的漏尿情况有多严重,以及考虑手术结果有没有任何可能出错的机会。
  
  经闭孔插入组的膀胱损伤风险比较低(0.6%,耻骨后组为4.5%),而大血管或内脏损伤率、平均手术时间、手术失血量、住院天数等,也都是经闭孔插入组较低;经闭孔组术后排尿功能障碍方面的表现也比较好(4%,耻骨后组为7%)。
  
  经闭孔手术的缺点是,短期内的腹股沟疼痛率比较高(6.4% vs 1.3%),另有四篇试验的一些低质量证据显示,重复手术的需求高于耻骨后插入组。
  
  对于经闭孔技术,并无证据显示偏好使用内侧到外侧或是外侧到内侧插入,但是,对于耻骨后的带子,从底部往顶部的方法比从顶部往底部的路径更有效。
  
  在1-5年的追踪期间,任一种手术之后,带子侵蚀到阴道的整体比率为大约2%,两组的性交时疼痛比率也都很低。
  
  本篇系统性回顾的81篇试验中,共有12,113名妇女、55篇试验(8652名参与者)直接比较耻骨后吊带与经闭孔吊带,有中等质量的证据显示,在12个月时,任一种路径都可有效缓解约80%妇女的症状。
  
  不过,报告5年资料的少数研究中,任一组的个案治癒率平均约为70%,经闭孔组介于43%-92%,耻骨后组为51%-88%。
  
  资深作者、英国Cumbria Morecambe Bay国家健康服务信托基金大学医院的Joseph Ogah在新闻稿中表示,我们必须更加了解这些妇女的长期结果,而不是在这领域开始任何新试验,我们必须从现有的试验获得长期追踪。
  
  虽然这篇回顾比较了这个领域的两个最常见手术方式,对于它们和已经被它们取代的旧式手术比较,我们还需要更有力的证据。
  
  研究者查找考科蓝尿失禁分组登记资料库(Cochrane Incontinence Group Specialised Register),检视了随机分组或半随机控制试验,这两类型试验组都包含了一种尿道中段吊带手术。回顾分析的作者们独立检视可能符合条件之研究的研究方法质量,以及从纳入的试验摘录资料。
  
  资料来源:http://www.24drs.com/
  
  Native link:Midurethral Sling Helpful for Stress Urinary Incontinence

Midurethral Sling Helpful for Stress Urinary Incontinence

By Laurie Barclay, MD
Medscape Medical News

Midurethral sling operations for stress urinary incontinence in women have a good safety pro?le and are highly effective in the short and medium term, based on a systematic review published online July 1 in the Cochrane Database of Systematic Reviews.

However, the sling implant is made of an artificial, nonabsorbable plastic mesh tape, which may explain reports of postoperative pain and injury. Although evidence is also building for long-term efficacy, differences in complications and the long-term need for repeat surgery should be weighed when considering sling surgery.

An additional consideration is use of the retropubic route, in which the tape passes behind the pubic bone and exits via the abdomen, or the transobturator route, in which the tape passes side-to-side and exits via the groin.

"This is a very significant review informing women about the minimally invasive surgical options available for the treatment of this very debilitating condition," lead author Abigail A. Ford, MD, from the Bradford Royal Infirmary, United Kingdom, said in a news release. "It helps to give women more information to make an informed choice."

However, Dr Ford cautions women to try less invasive alternatives such as pelvic floor (Kegel) exercises before contemplating any type of surgery. "As all surgery carries some risk, women must weigh up carefully how much they are troubled by their urine leakage against taking a small chance that things may go wrong as a result of surgery," she said.

Risk for bladder damage during surgery was lower with transobturator insertion (0.6% vs 4.5% in the retropubic group), as were rates of major vascular or visceral injury, mean operating time, operative blood loss, and length of hospital stay. The transobturator group also fared better in terms of postoperative voiding dysfunction (4% vs 7% in the retropubic group).

The downside of the transobturator procedure was greater likelihood of groin pain in the short term (6.4% vs 1.3%), as well as some low-quality evidence from four trials suggesting an increased need for repeat surgery compared with retropubic insertion.

For transobturator techniques, there was no evidence favoring the use of a medial-to-lateral vs a lateral-to-medial insertion, but for retropubic tapes, a bottom-to-top route was more effective than a top-to-bottom route.

At 1- to 5-year follow-up, the overall rate of erosion of the tape into the vagina was about 2% after either type of surgery, and both groups also had low rates of pain during sexual intercourse.

Of 81 trials included in the systematic review, enrolling a total of 12,113 women, 55 trials (8652 participants) directly compared retropubic and transobturator slings. There was moderate-quality evidence that either route effectively resolved symptoms in approximately 80% of women at around 12 months.

However, few studies reported 5-year data, and among these, subjective cure rates in either group were approximately 70%, ranging from 43% to 92% in the transobturator group, and from 51% to 88% in the retropubic group.

"We need to know more about what happens to women in the long term," senior author Joseph Ogah, MBBS, MRCOG, from University Hospitals of Morecambe Bay National Health Service Foundation Trust, Cumbria, United Kingdom, said in the news release. "Rather than starting any new trials in this area we need to obtain long-term follow up from the existing trials.

"Although this review compares the two most common operations in current practice in the developed world, we need more robust evidence about how well they compare with the older types of surgery that they have superseded."

The investigators identified randomized or quasirandomized controlled trials in which both trial groups involved a midurethral sling operation by searching the Cochrane Incontinence Group Specialised Register. Two review authors independently examined the methodological quality of potentially eligible studies and extracted data from the included trials.

The National Institute for Health Research funded this review. Dr Ford received funding from Johnson & Johnson for part sponsorship to attend the 2014 International Urogynaecology Association conference. One coauthor received funding from Astellas for attendance at the European Urogynaecological Association meeting in Berlin. Dr Ogah received funding for conference registration fees and speaker honoraria by Astellas UK and was sponsored to attend workshops by Johnson & Johnson and Speciality European Pharma. The remaining coauthor has disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online July 1, 2015.

    
相关报导
肉毒杆菌对于膀胱过动症的神经调节效果可能最好
2016/10/21 上午 10:08:58
骨盆底运动对于男性尿失禁无效
2011/7/15 下午 02:43:32
逆耻骨相较于经闭孔尿道中段吊带对压力型尿失禁一样有效
2010/6/17 下午 05:52:00

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页