Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1010 - файл
.pdf
Chapter 29
Chapter 29 Long-term Results of Surgery for Stress Uri-
Long-term Results of Surgery
for Stress Urinary Incontinence –
A Urologist’s View
Prasad Patki,Rizwan Hamid, Julian R. Shah
397
29
Contents
29.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . 398
29.2 Mechanism of Urinary Continence . . . . . . . . . . . . 398
29.3 Treatment for Stress Urinary Incontinence . . . . . . . . 398
29.3.1 Surgery for Stress Incontinence . . . . . . . . . . . . . . 398
29.3.1.1 Outcome of Surgery for Stress Incontinence . . . . . . . 399
29.3.2 Open Colposuspension . . . . . . . . . . . . . . . . . . . 399
29.3.3 Laparoscopic Colposuspension . . . . . . . . . . . . . . 400
29.3.4 Endoscopic Bladder Neck Suspensions . . . . . . . . . . 400
29.3.5 Suburethral Slings . . . . . . . . . . . . . . . . . . . . . 400
29.3.6 Periurethral Injections . . . . . . . . . . . . . . . . . . . 400
29.3.7 Artificial Urinary Sphincter . . . . . . . . . . . . . . . . 401
29.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . 401
References . . . . . . . . . . . . . . . . . . . . . . . . . . 401
29
398
Prasad Patki,Rizwan Hamid, Julian R.Shah
29.1 Background
The International Continence Society (ICS) defines urinary incontinence as the complaint of any involuntary leakage of urine, and stress incontinence as a complaint of
involuntary leakage on effort or exertion, or on sneezing or coughing (Abrams et al.
2002).
Stress urinary incontinence (SUI) is generally more common in women than men;
its presence has great social, physical, economical and psychological impact on these
women.A recent European study conducted in four countries showed that overall 35%
of women reported incontinence.Stress incontinence was the commonest form (37%),
followed by mixed (33%) and urge (20%) (Hunskaar et al. 2004). The true prevalence
of stress incontinence is probably higher than this, as actual urodynamic evaluation
reveals that mixed incontinence may be overdiagnosed at the expense of SUI (Sandvik
et al. 1995).
29.2 Mechanism of Urinary Continence
Continence is achieved by normal interplay of anatomical and physiological properties of the bladder,pelvic floor and urethral sphincter complex.The nervous system also plays a major part by coordinating the activity in all these components.
The role of pelvic floor in providing the support to the bladder and urethra and allowing normal abdominal pressure transmission to proximal urethra is used as a basis in some of the surgical repairs designed for stress incontinence.
29.3 Treatment for Stress Urinary Incontinence
The aim of treatment for stress incontinence is to render the patient continent by the
least invasive method with a high cure rate over a long period.
Surgery is the main treatment of stress incontinence.However, conservative measures such as pelvic floor muscle training and biofeedback, electrical and magnetic
stimulations and vaginal weighted cones are also used with variable success.Until recently, the role of medical treatment in SUI has remained limited.Various agents have
been used off label, including estrogen replacement, alpha-adrenergic agonists, betaadrenergic antagonists and tricyclic antidepressants.However, none have demonstrated sufficient effect to justify widespread acceptance or approval (Viktrup and Bump
2003).Duloxetine, which is a potent selective serotonin and norepinephrine re-uptake
inhibitor (SNRI),has been the focus of much recent attention.
In general, the surgical treatment of SUI has proved to be far more successful than
the nonsurgical treatment.
29.3.1 Surgery for Stress Incontinence
Surgical treatments of urodynamic stress incontinence generally aim to improve the
support to the urethrovesical junction. They include:
쐽 Retropubic colposuspension such as the Burch, Marshall Marchetti Krantz
(MMK) and vaginal obturator shelf (VOS) procedures
Chapter 29 Long-term Results of Surgery for Stress Urinary Incontinence
쐽 Laparoscopic colposuspension
쐽 Suburethral sling procedure such as the rectus sheath sling
쐽 Tension-free vaginal tape (TVT ) and the recently added transobturator tape
(TOT)
쐽 Needle suspensions: Stamey, Raz and Pereyra
쐽 Periurethral injectables
In addition to these artificial urinary sphincters, bone anchored slings and four-corner suspensions have been used to treat urodynamic stress incontinence.
The wide variety of treatment options in stress incontinence indicates a lack of
clear consensus as to the superiority of one procedure over others.Even though there
is a disagreement on the precise mechanism by which continence is achieved, open
retropubic colposuspension has been regarded as the gold standard treatment for urinary incontinence.
29.3.1.1 Outcome of Surgery for Stress Incontinence
Since 1949 when Marshall and co-workers described their retropubic vesicourethral
suspension, the quest for an ideal procedure has been ongoing. Ideally the best outcome would include a cure from incontinence over the long term with a short, simple
procedure associated with the least morbidity and the highest cost effectiveness.
There are over 1,000 publications on the outcome of surgeries for the urodynamic
stress incontinence but many of them are not randomized, have poor methodology
and provide inadequate data on complications (Black and Downs 1996). Meaningful
and clinically useful recommendations can be derived based on a handful of systematic reviews that have integrated the results from high-quality studies.
399
29.3.2 Open Colposuspension
In 2003 the Cochrane database systematic review studied 33 trials of the open colposuspensions.The overall cure rates were 68.9%–88% with 70% of patients expected to
be dry at the end of 5 years (Lapitan et al. 2003).The results with the Burch procedure
appear to be durable with longer follow-up, with 69% subjective and objective cure
rates at a mean follow-up of 13.8 years (Alcalay et al.1995). One can expect a decline in
the cure rate of only 15%–20% even beyond 5 years with open colposuspensions, which
currently is unmatched by other surgical techniques (Lapitan et al. 2003).
Although the medium- and short-term results of the MMK procedure have been
good, on longer-term follow up,the subjective cure rate at 17 years is 41% (Clemens et
al. 1998). Czaplicki and colleagues noted decreasing continence rates with the MMK
procedure from 77% at 1 year to 28% at 10 years (Czaplicki et al. 1998). Hegarty et al.
noted a mean continence rate of 61% with follow-up up to 22 years.All failures in this
study occurred within the first 2 years (Hegarty et al. 2001). Secondary colposuspensions performed after primary surgical failure also fare well, with 71% subjective and
80% objective cure rates at a mean follow up of 4 years. Although there was an increased incidence in surgery for prolapse, at 5 years 65% were still dry (Thakar et al.
2002). Age, body habitus and complexity of treatment, collagen deterioration, con-
29
400
Prasad Patki,Rizwan Hamid, Julian R.Shah
comitant bladder overactivity, surgical skill of the surgeon and associated pelvic abnormalities play a part in the long-term outcome of colposuspensions.
29.3.3 Laparoscopic Colposuspension
Laparoscopic colposuspension was introduced by Vancaillie in 1991 (Vancaillie and
Schuessler 1991). The intended benefits included better visualization,shorter hospital
stay and lesser morbidity with associated cost effectiveness. Summit et al., in their randomized, prospective study, found short-term success comparable to the open procedure but on longer follow-up laparoscopic retropubic suspensions appears to fail
(Summitt et al. 2000). McDougall (1999) noted only 30% cure of SUI at 45 months follow-up (McDougall et al. 1999). Burton (1999) noted significantly more failures at
5 years in the laparoscopic group (Burton 1999).
29.3.4 Endoscopic Bladder Neck Suspensions
Needle suspensions such as Stamey and Gittes have not stood the test of time. Early
success rates were replaced by long-term failures with 28% dry at 9 years with the Stamey procedure and 14% dry at 5.3 years with the Gittes procedure (Nigam et al. 2000).
29.3.5 Suburethral Slings
Suburethral slings have been widely used in the treatment of SUI. Culligan et al. reported better results with slings (100% dry) compared to colposuspensions (84.6%
dry) at a mean follow-up of 72.6 months (Culligan et al. 2003).However, other than the
tension-free vaginal tape (TVT), which utilizes Prolene mesh tape,there is insufficient
data to draw meaningful conclusions as to whether alternative slings (e.g., PTFE, rectus fascia,) are as effective as open colposuspension in the management of SUI (Bezerra and Bruschini 2001). It has been reported that the cure rate for TVT is similar to colposuspension at 6 months and 1 year. However, the hospital stay and hence cost for
TVT are about 25% lower; comparative data over the long term will show if it is as effective as colposuspension (Bezerra and Bruschini 2001). Complications with TVT
such as bladder injury (7.5%–36.3%), significant bleeding (0.9%), nerve injury (0.9%)
and urinary tract infection (6.1%) are reported in the literature (Nilsson and Kuuva
2001; Moran et al. 2000). Patients also report having temporary obstruction
(12%–49%), dysuria (31.5%), and urge incontinence (6.4%–28.6%) after the TVT procedure (Jeffry et al. 2001; Al Badr et al. 2003). Transobturator tape (TOT) is a novel
minimally invasive procedure that is awaiting full evaluation. TOT avoids the perforation of the pelvic floor, thus minimizing the incidence of bladder injury. It can be performed in previously operated patients. The initial results indicate that the technique
is efficient, safe and simple to perform (Gunnemann et al. 2004).
29.3.6 Periurethral Injections
Periurethral injections have been used as a minimally invasive method. The randomized trials reported have used collagen, Macroplastique, carbon particles and autolo-
Chapter 29 Long-term Results of Surgery for Stress Urinary Incontinence
gous fat.A recent review concluded that bulking agents may be used with limited benefit in the short term (1 year), but that results are still inferior to colposuspension
(58%–85%) (Pickard et al. 2003).There is no evidence that these agents should be used
routinely as the first line of treatment. However, in high-risk patients they may be a
useful option for relief of symptoms in the short term, although multiple injections
may be required to achieve desired results. Pain, infection, voiding dysfunction, bladder overactivity and migration of particles are some of the longer-term complications
noted with periurethral agents.
29.3.7 Artificial Urinary Sphincter
The artificial urinary sphincter has been used in cases refractory to the methods discussed in the preceding sections. The success rate ranges from 91% to 99%, with an
erosion rate of between 7% and 29%. It may be concluded that AUS is an acceptable
method of managing SUI after the failure of other surgical options (Kowalczyk and
Mulcahy 2000). In spite of high cure rates with surgical treatment, there is a postoperative voiding dysfunction rate of 5%–20%, which may be successfully treated with
urethrolysis (Dunn et al.2004).
29.4 Summary
Stress incontinence is the most common type of incontinence seen in women.It has a
major impact on their quality of life. Currently conservative treatments such as pelvic
floor muscle training have limited success but require high levels of compliance and
perseverance. Clearly there is a need to develop effective pharmacological treatment.
New medical advances such as duloxetine appear to be promising.At present, surgery
remains the most effective option.Although colposuspension is still considered to be
the gold standard,minimally invasive procedures such as TVT have the potential to be
an effective alternative. None of the procedures to date have significant data on more
than 20 years follow-up. Because of the different components to incontinence,a single
surgical procedure cannot cure every case. Hence,each case should be considered on
its own merit to determine the most appropriate method of treatment.Importantly, as
patients become more informed,they should be actively involved in the decision-making process. In the end, only a systematic review of good structured studies over the
long term can help make an informed choice easy for our patients.
401
References
Abrams P, Cardozo L,Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A,Wein
A (2002) The standardisation of terminology of lower urinary tract function: report from the
Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn
21 : 167–178
Al Badr A, Ross S, Soroka D, Minassian VA, Karahalios A,Drutz HP (2003) Voiding patterns and
urodynamics after a tension-free vaginal tape procedure.J Obstet Gynaecol Can 25 :725–730
Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20 year follow up. Br J Ob-
stet Gynaecol 102:740–745
Bezerra CA, Bruschini H (2001) Suburethral sling operations for urinary incontinence in wom-
en. Cochrane Database Syst Rev CD001754
29
402
Prasad Patki,Rizwan Hamid, Julian R.Shah
Black NA, Downs SH (1996) The effectiveness of surgery for stress incontinence in women: a
systematic review.Br J Urol 78:497–510
Burton G (1999) A five year prospective randomised urodynamic study comparing open lapar-
oscopic colposuspension. Neurourol Urodyn 18 :295–296
Clemens JQ, Stern JA, Bushman WA, Schaeffer AJ (1998) Long-term results of the Stamey bladder
neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure. J Urol
160: 372–376
Culligan PJ, Goldberg RP, Sand PK (2003) A randomized controlled trial comparing a modified
Burch procedure and a suburethral sling: long-term follow-up.Int Urogynecol J Pelvic Floor
Dysfunct 14 :229–233
Czaplicki M, Dobronski P, Torz C, Borkowski A (1998) Long-term subjective results of Marshall-
Marchetti-Krantz procedure. Eur Urol 34:118–123
Dunn JS Jr,Bent AE,Ellerkman RM, Nihira MA,Melick CF (2004) Voiding dysfunction after sur-
gery for stress incontinence: literature review and survey results. Int Urogynecol J Pelvic
Floor Dysfunct 15 :25–31
Gunnemann A,Heleis W, Pohl J,Paliakoudis I,Thiel R (2004) The transobturator tape (TOT).A
minimally-invasive procedure for the treatment of female urinary stress incontinence. Uro-
loge A 43 :1106–1110
Hegarty PK, Power PC, O’Brien MF, Bredin HC (2001) Longevity of the Marshall-Marchetti-
Krantz procedure. Ann Chir Gynaecol 90 :286–289
Hunskaar S,Lose G, Sykes D,Voss S (2004) The prevalence of urinary incontinence in women in
four European countries. BJU Int 93: 324–330
Jeffry L, Deval B, Birsan A, Soriano D, Darai E (2001) Objective and subjective cure rates after ten-
sion-free vaginal tape for treatment of urinary incontinence.Urology 58: 702–706
Kowalczyk JJ, Mulcahy JJ (2000) Use of the artificial urinary sphincter in women. Int Urogynecol
J Pelvic Floor Dysfunct 11: 176–179
Lapitan MC, Cody DJ, Grant AM (2003) Open retropubic colposuspension for urinary inconti-
nence in women. Cochrane Database Syst Rev CD002912
Marshall FV, Marchetti AA, Krantz KE (1949) The correction of stress incontinence by simple
vesicourethral suspension. Surg Gynecol Obstet 88: 509–518
McDougall EM,Heidorn CA, Portis AJ, Klutke CG (1999) Laparoscopic bladder neck suspension
fails the test of time. J Urol 162:2078–2081
Moran PA, Ward KL, Johnson D,Smirni WE, Hilton P, Bibby J (2000) Tension-free vaginal tape for
primary genuine stress incontinence: a two-centre follow-up study. BJU Int 86: 39–42
Nigam AK, Otite U, Badenoch DF (2000) Endoscopic bladder neck suspension revisited: long-
term results of Stamey and Gittes procedures.Eur Urol 38: 677–680
Nilsson CG, Kuuva N (2001) The tension-free vaginal tape procedure is successful in the major-
ity of women with indications for surgical treatment of urinary stress incontinence. BJOG
108: 414–419
Pickard R,Reaper J,Wyness L, Cody DJ,McClinton S, N’Dow J (2003) Periurethral injection ther-
apy for urinary incontinence in women.Cochrane Database Syst Rev CD003881
Sandvik H, Hunskaar S,Vanvik A, Bratt H, Seim A, Hermstad R (1995) Diagnostic classification of
female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidem-
iol 48: 339–343
Summitt RL, Lucente V, Karramm MM et al (2000) Randomised comparison of laparoscopic and
transabdominal Burch urethropexy for treatment of genuine stress incontinence. Obstet
Gynecol 95 [Suppl 1]:52
Thakar R, Stanton S, Prodigalidad L, den Boon J (2002) Secondary colposuspension: results of a
prospective study from a tertiary referral centre. BJOG 109 :1115–1120
Vancaillie TG, Schuessler W (1991) Laparoscopic bladderneck suspension. J Laparoendosc Surg
1: 169–173
Viktrup L, Bump RC (2003) Pharmacological agents used for the treatment of stress urinary in-
continence in women.Curr Med Res Opin 19: 485–490
Chapter 30
Chapter 30 Long-term Results After Fecal Incontinence
Long-term Results
After Fecal Incontinence Surgery
Tilman T. Zittel
403
30
Contents
30.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 404
30.2 Study Inclusion Criteria . . . . . . . . . . . . . . . . . . . 404
30.3 General Study Weaknesses . . . . . . . . . . . . . . . . . . 405
30.4 Presentation of the Study Results . . . . . . . . . . . . . . 406
30.5 Overlapping Sphincteroplasty . . . . . . . . . . . . . . . . 407
30.6 Postanal Repair . . . . . . . . . . . . . . . . . . . . . . . . 407
30.7 Preanal Repair (Anterior Levatorplasty
and Sphincteroplasty) . . . . . . . . . . . . . . . . . . . . 412
30.8 Total Pelvic Floor Repair . . . . . . . . . . . . . . . . . . . 412
30.9 Dynamic Graciloplasty . . . . . . . . . . . . . . . . . . . . 415
30.10 Artificial Bowel Sphincter . . . . . . . . . . . . . . . . . . 415
30.11 Sacral Nerve Stimulation . . . . . . . . . . . . . . . . . . . 420
30.12 Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . 420
30.13 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 423
References . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
30
404
Tilman T.Zittel
30.1 Introduction
Surgery has been a mainstay of incontinence treatment in selected cases since more
than 30 years. However, surgery has never been compared directly to conservative
treatment forms such as medical treatment, pelvic floor exercises or biofeedback
training. Further, most procedures employed have never been compared in a randomized way and with adequate patient numbers. The number of patients treated surgically for fecal incontinence and described retrospectively surpasses 10,000, but only 110
patients have been included in four trials that prospectively randomized surgical
treatment.This small number of relevant trials with small sample sizes and other methodological weaknesses made it impossible to identify or refute important differences between different surgical procedures (Malouf et al. 2001; Bachoo et al. 2003).
Several factors might be responsible for this lack of inclusion of patients in randomized trials and the resulting insecurity regarding the best surgical treatment for
fecal incontinence. There is a wide variety of underlying etiologies for fecal incontinence, starting with anal atresia in newborns and ending with a slow deterioration of
sphincter function or central cognitive functions over the years in elderly persons
(Jorge and Wexner 1993). Furthermore, fecal incontinence is highly variable with respect to type (urge, passive or both), clinical severity and its effects on individual patients (Malouf et al. 2001). It is therefore difficult to recruit homogenous patient
groups that might be suitable for properly designed trials, and randomized controlled
comparisons present formidable ethical and practical problems (Malouf et al. 2001).
Prospective multicenter studies have been conducted in recent years to describe the
results of newer surgical treatment forms,such as the dynamic graciloplasty or the artificial bowel sphincter (Madoff et al. 1999; Matzel et al. 2001a; Wong et al. 2002).Although this was a step forward, these studies did not compare different treatment
forms, and the reproducibility of their results in a general setting is doubtful,since only centers with a high degree of expertise participated. These centers will not be able
to treat the large patient numbers that suffer from major fecal incontinence,which was
defined as the soiling of stool several times per month and its prevalence being estimated around 2% in the adult population in Western industrialized countries (Nelson
et al. 1995; Kalantar et al.2002; Perry et al. 2002).Regardless of the etiology or the degree of fecal incontinence,there is currently no single standard surgical procedure for
fecal incontinence (Malouf et al.2001). Under these premises, this review will describe
the most commonly used surgical treatment forms for fecal incontinence.
30.2 Study Inclusion Criteria
Seven surgical procedures were included (overlapping sphincter repair, postanal repair, preanal repair, total pelvic floor repair, dynamic graciloplasty, artificial bowel
sphincter, sacral nerve stimulation), representing the vast majority of patients being
described in peer-reviewed journals for surgical fecal incontinence treatment.A Medline search from 1966 to February 2004 was conducted, using the terms of the surgical
procedures named above and “anal,”“fecal,” faecal,”“incontinence,” and “surgery.”A total of 979 abstracts were screened, of which 220 articles were identified that described
the results of fecal incontinence treatment with one of the surgical procedures. These
articles were copied and read thoroughly. In addition,six standard textbooks of colorectal surgery were screened in order not to miss relevant study results (Keighley and
Chapter 30 Long-term Results After Fecal Incontinence Surgery
Williams 1993; Nicholls and Dozois 1997; Corman 1998; Beck and Wexner 1998; Phillips
1998; Pemberton et al.2002).
A number of criteria had to be fulfilled for a study to be included in this review.
These criteria were chosen arbitrarily, and some general study weaknesses, which are
discussed in the next section, had to be accepted in order to come to a result at all.The
inclusion criteria were as follows:
쐽 A description of the underlying etiology of fecal incontinence
쐽 A defined grading of fecal incontinence before and after surgical treatment
쐽 A mean follow-up of at least 2 years (minimum mean follow-up of 12 months,
if only limited data available)
쐽 The availability or the possibility to calculate actual patient numbers
with regards to categories of treatment success or treatment failure
30.3 General Study Weaknesses
Virtually all studies on the surgical treatment for fecal incontinence are retrospective,
nonrandomized, uncontrolled reports of centers with an assumed degree of excellence, usually all patients being operated by one to three surgeons with a specific interest and experience in the field. In these studies,the surgical procedures are described
under the terms generally used, but considerable differences regarding patient mix,
preoperative diagnostic work-up, preoperative bowel lavage, the surgical technique
used, the perioperative antibiotic regime, the postoperative medical or physical treatment, patient follow-up and the description of the study results exist.
There is a considerable patient mix (see Table 30.1), which limits the possibility to
extrapolate study results to a single patient that needs advice regarding the best treatment form.From a scientific point of view, the results of the different studies cannot be
405
Table 30.1. Surgical treatment of fecal incontinence – general study weaknesses
Patient selection and previous medical or physical treatment failures not described
Low patient numbers (usually below 50 patients per study)
Mix of female and male patients (usually large majority of female patients)
Wide range of patient age (several decades between youngest and oldest patient)
Variety of etiologies for fecal incontinence included in one study
Varying degrees and numbers of birth traumas
Varying duration of fecal incontinence (years to decades)
Patients included with urinary and fecal incontinence
Varying percentage of patients being previously operated for fecal incontinence
Differences in pre-,peri- and postoperative handling
Variation of surgical procedures,varying usage of a temporary diverting stoma
Development of new technologies, varying experience with new technologies
Follow-up of patients varying from telephone interview to intensive diagnostic work-up
Wide range of follow-up time included in the same study (several months to several years)
Wide variety to describe study results (subjective measures, incontinence grading,
incontinence scoring, general quality of life, disease-specific quality of life)
Influence of aging on study results unknown
Possibility of the same patients included in several study reports
30
406
Tilman T.Zittel
compared directly. However, to review, analyze and summarize the data available
might give an estimate of the success and failure rates of surgical procedures for fecal
incontinence,which is important for patients and surgeons to provide a realistic view
and to avoid overly optimistic expectations by the treatment options available.
30.4 Presentation of the Study Results
From the literature, there are no generally accepted definitions available regarding the
terms “treatment success” or “long-term results” in fecal incontinence treatment, and
the determination of success remains an unresolved problem in fecal incontinence
surgery (Soffer and Hull 2000; Madoff et al. 2000). Over the years, the description of
the study results has improved from subjective and biased terms such as “excellent,”
“moderate” or “poor” (such studies were excluded in this review), to grading systems
(grading in full continence, incontinence for gas, liquid or solid stool and other grading systems [Baig and Wexner 2000; Baxter et al. 2003]), scoring systems (Cleveland
Clinic Incontinence Score and other scoring systems [Jorge and Wexner 1993; Baxter et
al. 2003]), general quality-of-life measures (SF-36 and other measures [Malouf et al.
2001; Baxter et al. 2003]), and eventually to a disease-specific quality-of-life measure
(Fecal Incontinence Quality of Life Scale [Rockwood et al. 2000]). The latter is probably best-suited to describe the impact of a disease or the impact of a treatment on a
given person (Hullfish et al.2002; Baxter et al. 2003), as disease-specific quality of life
has been shown to decrease with increasing incontinence (Gutierrez et al. 2004). Although this represents scientific progress and provides better estimates of treatment
results,the measurement of fecal incontinence continues to evolve (Baxter et al. 2003).
It is therefore impossible to directly compare the results of studies that used different
treatment outcome measures.
When judging success of fecal incontinence surgery, it is important to know what
the investigators judge as success (Soffer and Hull 2000). In this review, only studies
were included that categorized the study results as follows:
쐽 Full continence (continence for gas,liquid and solid stool; rare gas leakage
possible, usually less than once per month)
쐽 Success (continence for liquid and solid stool; rare stool leakage or soiling
possible, usually less than once per month)
쐽 Improvement (continence for solid stool, if preoperative not possible;
soiling and wearing of pads possible)
쐽 Failure (no improvement,incontinence for solid stool or reoperation)
In the tables, the patient numbers in the categories “full continence,” “success” and
“improvement” were added up, meaning that the category “success” includes the patients with “full continence”and the category “improvement”the patients from the categories “full continence”and “success.” The difference between the category “improvement” and the total number of patients represents the failure rate. Subtracting the
number of patients of the category “full continence” from the number of patients of
the category “success” gives the actual number of patients of the latter category, and
subtracting the number of patients of the categories “full continence” and “success”
from the number of patients of the category “improvement” also gives the actual number of patients of the latter category.
Соседние файлы в папке @xirurgi_2025