Anterior vaginal repair for urinary incontinence in women

 

Abstract

Background

Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.

Objectives

To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.

Selection criteria

Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.

Data collection and analysis

Both reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.

Main results

Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.

A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95% CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.

Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.

In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.

Authors' conclusions

There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.

 

Plain language summary

Anterior vaginal repair for urinary incontinence in women

Urinary incontinence is the inability to prevent urine leakage. Stress urinary incontinence is loss of urine when a person coughs or exercises. Damage to the muscles that hold up the bladder, and injuries to the nerves during childbirth, may be causes. When non-surgical methods, such as exercising the muscles in the pelvic floor (the base of the abdomen), have not worked, surgery is sometimes used to lift and support the bladder. Anterior vaginal repair aims to achieve this, operating through the vaginal wall. The review of ten trials in 1012 women found some evidence that surgery through the abdomen may be better than vaginal repair. However, there was not enough information about side-effects, or in comparison with other physical or surgical methods of treating urine leakage.

 

摘要

背景

尿失禁婦女的陰道前壁修復

陰道前壁修復術(前陰道縫合術)是傳統上用來治療中度或重度婦女尿失禁的手術。大約有三分之一的成年女性有尿失禁的經驗

目標

決定陰道前壁修復(前陰道縫合術)用在尿失禁上跟其他處置比較上效果有何差異

搜尋策略

我們搜尋了Cochrane Incontinence Group Specialised Trials Register(搜尋到searched 28 February 2007)以及其他相關文章的參考清單

選擇標準

隨機或半隨機試驗(Randomised or quasirandomised trials)，包括用陰道前壁修復的尿失禁治療方式

資料收集與分析

本文兩位作者各自得到資料並評估試驗的品質。另外連繫三位試驗的研究者以獲得更多的資訊

主要結論

我們收納了10份文獻其中包含385位接受陰道前壁修補的女性以及627位接受其他手術的女性。1篇小文獻提供了不足夠的證據來評估陰道前壁修補跟其他物理治療的差異。陰道前壁修補術跟膀胱頸針懸吊術(bladder neck needle suspension)比較上呈現相似結果(RR 1年後失敗 1.16, 95% CI 0.86 to 1.56)但是臨床上重大的相異處卻不能明確地排除。沒有1篇文獻提供了陰道前壁修補跟尿道下懸吊手術(suburethral sling operations)、腹腔鏡陰道懸吊術(laparoscopic colposuspensions)或其他陰道手術的比較。根據8篇文獻的病人治癒率結果，陰道前壁修補術比開腹腔恥骨後尿道固定術(open abdominal retropubic suspension)來的比較沒效，中期結果(1年到5年內的失敗率陰道前壁術後 97/259 (38%) 比57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08)以及長期結果(手術5年後，(49/128 (38%) 比31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01))。其中有3篇文獻提供的證據指出這些結果反映出需要更多重複的尿失禁手術(25/107 (23%) 比 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94)。這些發現結果並沒有包含與脫垂(骨盆腔鬆弛)共存。雖然有一些婦女在陰道前壁手術後有脫垂(RR 0.24, 95% CI 0.12 to 0.47)，之後的脫垂手術似乎同樣常見於陰道手術後(3%)及腹腔手術後(4%)。至於開腹腔恥骨後尿道固定術的種類，大部分的資料都是跟陰道前壁修補與Burch陰道懸吊術比較有關。有比較少的資料描述陰道前壁修補跟MarshallMarchettiKrantz 手術的比較與跟Burch陰道懸吊術比較是一致的

作者結論

對於婦女的原發應力性尿失禁，並沒有足夠的資料可以用來比較陰道前壁修補與物理性治療或針懸吊術。根據8篇文獻治癒率主觀地判斷，開腹腔恥骨後尿道固定術似乎比陰道前壁修補術好，甚至在合併有脫垂的尿失禁婦女也是如此(6篇文獻)。在開腹手術後再次的尿失禁手術需要是減少的。然而，關於術後的併發症及罹病率並沒有足夠的資訊提供

翻譯人

本摘要由中國醫藥大學附設醫院蘇泓文翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

婦女尿失禁的陰道前壁修補。尿失禁是指無法避免的尿滲漏。應力性尿失禁是指當人咳嗽或運動時有尿漏出情況。阻止膀胱排尿的肌肉受傷或是生產時的神經損傷都是可能的原因。一些非手術方法，像是運動骨盆腔(腹部底部)的肌肉通常沒有幫助，手術方法一般是用提高或支持膀胱的方式。陰道前壁修補術可以幫助達到此目標，手術方式是經過陰道壁。本文收納包含1012位婦女的10篇文獻發現了一些證據指出經由開腹手術是比陰道修補效果好。然而，並沒有足夠的資料提供關於副作用或是與其它物理性方法以及治療尿滲漏手術方法的比較