Surgery for urinary incontinence in women 65 years and older: a systematic review

被引:11
|
作者
Franzen, Karin [1 ,2 ]
Andersson, Gunnel [3 ]
Odeberg, Jenny [4 ]
Midlov, Patrik [5 ]
Samuelsson, Eva [6 ]
Stenzelius, Karin [7 ]
Hammarstrom, Margareta [8 ]
机构
[1] Univ Orebro, Sch Med, SE-70182 Orebro, Sweden
[2] Orebro Univ Hosp, Dept Obstet & Gynecol, S-70185 Orebro, Sweden
[3] Univ Orebro, Sch Hlth & Med Sci, SE-70182 Orebro, Sweden
[4] Swedish Council Hlth Technol Assessment SBU, Stockholm, Sweden
[5] Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden
[6] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden
[7] Malmo Univ, Dept Care Sci, Malmo, Sweden
[8] Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden
关键词
Elderly; Surgery; Systematic review; Urinary incontinence; FREE VAGINAL TAPE;
D O I
10.1007/s00192-014-2573-9
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction and hypothesis Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population >= 65 years of age. Methods Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be >= 65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life. The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD) as well as risk difference (RD) and the 95 % CI were calculated. Results Five studies-all on the suburethral sling procedure in women-that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge. Conclusion The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.
引用
收藏
页码:1095 / 1102
页数:8
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