Re: Retropubic versus Transobturator Tension-Free Vaginal Tape (TVT vs TVT-O): Five-Year Results of the Austrian Randomized Trial.
Re: Retropubic versus Transobturator Tension-Free Vaginal Tape (TVT vs TVT-O): Five-Year Results of the Austrian Randomized Trial.
复制标题
回复：耻骨后与经闭孔无张力阴道胶带（TVT 与 TVT-O）：奥地利随机试验的五年结果。
DOI：
10.1097/01.ju.0000554118.78108.70
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发表时间：
2019
影响因子：
6.6
通讯作者：
A. Wein
中科院分区：
文献类型：
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作者：
A. Wein
编辑评论：近年来有一些关于膀胱过度活动症（OAB）与福尔斯和骨折之间的校正关联是否表现出明确的相关性的讨论。在783项潜在相关研究中，这些作者发现15项为膀胱过度活动症患者的核心分析提供了估计值。9项研究对福尔斯和骨折进行了前瞻性测量，6项研究进行了回顾性测量。一年内至少发生1次跌倒的OAB患者百分比范围为18.9%-50%，发生复发性或严重福尔斯的患者百分比范围为10.2%-56.0%。在包括非OAB比较样本的研究中，观察到OAB患者的福尔斯风险高于非OAB患者。据报道，OAB相关的福尔斯风险为1.3 - 2.3倍，而OAB相关的福尔斯和骨折归因风险的未校正百分比范围为3.7%-15.5%。女性和65岁或以上的人的风险增加。骨折分析显示点估计值升高，但大多数研究的效力不足，无法检测组间的统计学显著差异。作者认为，"这项研究的结果强调了OAB与福尔斯和骨折之间关系的强度，以及任何治疗对该风险影响的有限证据。"此外，他们引用了最近对OAB的药物治疗等跌倒管理策略的影响进行的系统性综述，该综述发现几乎没有证据表明此类策略可以减少福尔斯，并承认与抗胆碱能药物相关的跌倒风险增加可能会抵消在该人群中观察到的跌倒管理策略在减少福尔斯方面的任何益处。1这篇文章包括57个关于这个主题的精选参考文献。
Editorial Comment: There has been some discussion in recent years as to whether adjusted associations between overactive bladder (OAB) and falls and fractures demonstrate a definite correlation. Among 783 potentially relevant studies these authors found 15 that contributed estimates for the core analyses of patients with overactive bladder. Nine studies measured falls and fractures prospectively and 6 retrospectively. The percentage of patients with OAB experiencing at least 1 fall during a year ranged from 18.9% to 50%, and the percentage experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a nonOAB comparison sample a greater risk of falls was observed in patients with OAB compared to those without. A 1.3 to 2.3-fold OAB associated risk of falls was reported, while unadjusted percentage of attributable risk of falls and fractures associated with OAB ranged from 3.7% to 15.5%. Risk was increased in women and those age 65 years or older. Analysis of fractures revealed elevated point estimates but most studies were underpowered to detect the statistically significant difference between groups. The authors feel that “the findings in this study highlight both the strength of the relationship between OAB and falls and fractures, and the limited evidence of the impact of any treatment on that risk.” Furthermore, they cite a recent systematic review of the impact of continence management strategies, including pharmacotherapy for OAB, which identified little evidence that such strategies reduce falls and acknowledged that the increased fall risk associated with anticholinergic medications could counter any observed benefits of continence management strategies in decreasing falls in this population. 1 The article includes 57 well chosen references on the subject.