比较单切口尿道中吊带与膨胀剂治疗女性压力性尿失禁:一项非随机对照试验的基本原理。

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Nienke Osse, Marit Schonewille, Marian Engberts, Marco Blanker, Wenche Klerkx, Hugo Van Eijndhoven
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引用次数: 0

摘要

目的:中尿道吊带被认为是外科治疗压力性尿失禁(SUI)的金标准,其疗效高达80%。另一种治疗选择是使用膨胀剂,它在尿道粘膜下层制造一个人工肿块,疗效从64%到74%不等。虽然膨胀剂的并发症风险比中尿道吊带术低,但它们主要用于不能选择中尿道吊带术或中尿道吊带术不能治愈压力性尿失禁的情况。在这项研究中,我们为所有SUI患者在二级护理中提供单切口尿道中吊带手术和填充剂治疗之间的选择。我们想要检查患者对这两种手术的偏好和满意度。我们期望,提供这两种干预措施与标准化咨询相结合将导致高患者满意度。设计:在这项非随机对照试验中,266例患者将客观地接受两种干预措施的建议,之后所有患者将在单切口尿道中吊带和聚丙烯酰胺水凝胶(PAHG)之间进行选择,随后是SUI女性的标准护理程序。参与者/材料、环境、方法:从2021年1月1日起,所有客观证实患有中度至重度SUI的连续在妇科门诊就诊的成年患者(年龄在18至80岁之间)将有资格纳入本非随机研究。主要结局是患者1年的满意度,通过患者总体改善印象来衡量;次要结局是患者3个月时的满意度、3个月和1年的客观和主观治愈、不良事件、术后疼痛和成本效益。结果测量的差异将通过逻辑和线性回归分析进行评估,包括未调整和使用倾向评分进行协变量调整。结果:目前还没有结果。局限性:本研究设计的主要缺点是潜在的混杂偏倚。我们打算通过应用倾向评分来消除这种偏差。结论:通过设计一项非随机的患者偏好试验,我们不仅希望证明患者对两种干预措施都有很高的满意度,而且还希望深入了解pahg注射作为首选非保守治疗在女性SUI治疗中的可能作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparing Single-Incision Midurethral Sling with Bulking Agents for Female Stress Urinary Incontinence: Rationale for a Non-Randomized Controlled Trial.

Objectives: Midurethral slings are considered the gold standard for the surgical treatment of stress urinary incontinence (SUI), with an efficacy up to 80%. Another therapeutic option is the use of bulking agents, which create an artificial mass in the urethral submucosa, with an efficacy varying from 64% to 74%. Although bulking agents have a lower risk of complications than midurethral sling surgery, they are mainly used in case a midurethral sling is not an option or if midurethral sling surgery failed to cure stress urinary incontinence. In this study, we offer all patients with SUI in secondary care a choice between a single-incision midurethral sling procedure and treatment with a bulking agent. We want to examine patient preference and patient satisfaction for both procedures. We expect that offering both interventions in combination with standardized counselling will result in high patient satisfaction.

Design: In this non-randomized controlled trial, 266 patients will be objectively counselled for both interventions, after which all patients will choose between single-incision midurethral slings and polyacrylamide hydrogel (PAHG), followed by the standard care procedure for women with SUI.

Participants/materials, setting, methods: From January 1, 2021, onward, all consecutive adult patients (between 18 and 80 years of age) attending the outpatient gynaecology department with objectively confirmed, moderate to severe SUI will be eligible for enrolment in this non-randomized study. The primary outcome is patient satisfaction at 1 year, measured by the Patient Global Impression of Improvement; secondary outcomes are patient satisfaction at 3 months, objective and subjective cure at 3 months and 1 year, adverse events, post-operative pain, and cost-effectiveness. Differences in outcome measures will be assessed through logistic and linear regression analyses, both unadjusted and adjusted with covariate adjustment using the propensity score.

Results: No results are available yet.

Limitations: The major disadvantage of this study design is the potential confounding bias. We intend to eliminate this bias by applying propensity scoring.

Conclusion: By designing a non-randomized patient preference trial, we not only expect to demonstrate high patient satisfaction with both interventions but also provide insight into the possible role of PAHG-injections in the treatment of female SUI as a first-choice non-conservative treatment.

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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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