Determinants of postoperative outcomes of female genital fistula repair surgery.
Determinants of postoperative outcomes of female genital fistula repair surgery.
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DOI：
10.1097/aog.0b013e31826579e8
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发表时间：
2012-09
影响因子：
7.2
通讯作者：
Podder DC
中科院分区：
文献类型：
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作者：
Barone MA;Frajzyngier V;Ruminjo J;Asiimwe F;Barry TH;Bello A;Danladi D;Ganda SO;Idris S;Inoussa M;Lynch M;Mussell F;Podder DC
确定术后3个月瘘管修复结果的预测因素。我们在2007年至2010年间进行了一项多国前瞻性队列研究。术后3个月测量的结果包括瘘管闭合和瘘管闭合女性的残余尿失禁。潜在的预测因素包括患者和瘘管特征以及修复背景。采用多变量广义估计方程模型计算校正风险比（ARR）和95%置信区间（CI）。术后3个月返回随访的女性被纳入闭合分析的预测因素（n= 1，274）。膀胱尺寸小（ARR 1.57; 95% CI 1.39-1.79），既往修复（ARR 1.40; 95% CI 1.11-1.76），重度瘢痕形成（ARR 1.56; 95% CI 1.20-2.04），部分尿道受累（ARR 1.36; 95% CI 1.11-1.66）和完全尿道破坏/环周缺损（ARR 1.72; 95% CI 1.33-2.23）预测瘘闭合失败。3个月随访时瘘管闭合的女性被纳入残余尿失禁分析的预测因素（n=1041）。先前修复（ARR 1.37; 95% CI 1.13-1.65），重度瘢痕形成（ARR 1.35; 95% CI 1.10-1.67），部分尿道受累（ARR 1.78; 95% CI 1.27-2.48）和完全性尿道破坏或环周缺损（ARR 2.06; 95% CI 1.51-2.81）与残余尿失禁显著相关。生殖道瘘管闭合的预后与术前膀胱大小、既往修补、阴道瘢痕和尿道受累有关。
To determine predictors of fistula repair outcomes 3 months postsurgery. We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure, and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics, and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (ARR) and 95% confidence intervals (CI). Women who returned for follow-up 3 month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (ARR 1.57; 95% CI 1.39–1.79), prior repair (ARR 1.40; 95% CI 1.11–1.76), severe scarring (ARR 1.56; 95% CI 1.20–2.04), partial urethral involvement (ARR 1.36; 95% CI 1.11–1.66), and complete urethral destruction/circumferential defect (ARR 1.72; 95% CI 1.33–2.23) predicted failed fistula closure. Women with a closed fistula at 3 month follow-up were included in predictors of residual incontinence analyses (n=1041). Prior repair (ARR 1.37; 95% CI 1.13–1.65), severe scarring (ARR 1.35; 95% CI 1.10–1.67), partial urethral involvement (ARR 1.78; 95% CI 1.27–2.48), and complete urethral destruction or circumferential defect (ARR 2.06; 95% CI 1.51–2.81) were significantly associated with residual incontinence. The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement.