Update of AUA Guideline on the Surgical Management of Female Stress Urinary Incontinence
Update of AUA Guideline on the Surgical Management of Female Stress Urinary Incontinence
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DOI：
10.1016/j.juro.2010.02.2369
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发表时间：
2010-05-01
影响因子：
6.6
通讯作者：
Appell, Rodney A.
中科院分区：
文献类型：
--
作者：
Dmochowski, Roger R.;Blaivas, Jerry M.;Appell, Rodney A.
目的：我们更新了1997年美国泌尿学协会关于女性压力性尿失禁的指南。材料和方法：检索Medline(R)1994年以来的英文出版物和2002年12月至2005年6月发表的新文献。指标患者被定义为选择接受手术矫正压力性尿失禁的健康女性或选择接受这两种情况的治疗的健康女性。结果：共有436篇文章被确定为适合纳入Meta分析，另外155篇文章仅适用于并发症数据，因为后者对疗效结果的随访不足。手术疗效是使用主要证据文章中预先指定的结果来定义的。紧迫感(决心和从头开始)被列为疗效结果，因为它对生活质量有重大影响。主要疗效结果是压力性尿失禁的缓解，测量为完全干燥(治愈/干燥)或改善(治愈/改善)。并发症的分析与疗效结果类似。主观并发症(疼痛、性功能障碍和排尿功能障碍)也被列为单独的类别。结论：无论是否联合脱垂治疗，压力性尿失禁的外科治疗都在继续发展。新技术的出现对外科治疗算法产生了影响。膀胱镜检查已被添加为手术吊衣植入过程中的标准组件。
Purpose: We updated the 1997 American Urological Association guideline on female stress incontinence.Materials and Methods: MEDLINE (R) searches of English language publications from 1994 and new searches of the literature published between December 2002 and June 2005 were performed using identified MeSH terms. Articles were selected for the index patient defined as the otherwise healthy woman who elected to undergo surgery to correct stress urinary incontinence or the otherwise healthy woman with incontinence and prolapse who elected to undergo treatment for both conditions.Results: A total of 436 articles were identified as suitable for inclusion in the meta-analysis, and an additional 155 articles were suitable for complications data only due to insufficient followup of efficacy outcomes in the latter reports. Surgical efficacy was defined using outcomes pre-specified in the primary evidence articles. Urgency (resolution and de novo) was included as an efficacy outcome due to its significant impact on quality of life. The primary efficacy outcome was resolution of stress incontinence measured as completely dry (cured/ dry) or improved (cured/improved). Complications were analyzed similarly to the efficacy outcomes. Subjective complications (pain, sexual dysfunction and voiding dysfunction) were also included as a separate category.Conclusions: The surgical management of stress urinary incontinence with or without combined prolapse treatment continues to evolve. New technologies have emerged which have impacted surgical treatment algorithms. Cystoscopy has been added as a standard component of the procedure during surgical implantation of slings.