The effects of menopause on the quality of life and longterm outcomes of transobturator tape treatment in women with stres urinary incontinence

ABSTRACT Purpose: We aimed to investigate the effects of menopause on long-term outcomes of transobturator tape (TOT) surgery. Materials and Methods: Patients who underwent TOT surgery were evaluated under two groups as postmenopausal and premenopausal. The International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) questionnaires were completed by the patients at the 1st and 5th-year follow-up sessions. Patients with a postoperative UDI-6 and IIQ-7 score of <10 were considered as cured, those with lower postoperative scores compared to the preoperative period were regarded as improved, and the cases that had higher postoperative scores than preoperative values were interpreted as TOT failure. The TOT success rates were compared between the results obtained from UDI-6 and IIQ-7. Results: A total of 109 patients were included in the study (53 postmenopausal and 56 premenopausal). We contacted with 90 (48 premenopausal and 42 postmenopausal) women at 1st year control and 80 (44 premenopausal and 36 postmenopausal) women at 5th year control. There was a significant improvement in all of three questionnaires between the preoperative and post-operative 1st year control (ICIQ-SF: 15.5±2.5 vs. 1.8±4.3, p <0.001; IIQ-7: 68.9±9.8 vs. 2.75±15.2, p <0.001; UDI-6: 27.1±11.1 vs. 6.0±14.6, p <0.001) and the preoperative and post-operative 5th year control (ICIQ-SF: 15.5±2.5 vs. 3.1±5.3, p <0.001; IIQ-7: 68.9±9.8 vs. 9.6±26.7, p <0.001; UDI-6: 27.1±11.1 vs. 5.1±10.0, p <0.001). When we compared the premenopausal and postmenopausal patients in terms of recurrent urinary tract infection (UTI); 5 (12%) patients had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 1st year follow-up (p=0.039) and similarly the same 5 (13.9%) patients in follow-up had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 5th year follow-up (p=0.045). There were no significant differences between the premenopausal and postmenopausal patients in terms of TOT success rates at 1st and 5th year control, evaluated with UDI-6 (1st year: p=0.198 and 5th year: p=0.687) and IIQ-7 (1st year: p=0.489 and 5th year: p=0.608) questionnaires. Conclusions: Transobturator tape surgery is an effective and reliable method according to the long-term outcomes reported in this paper. In the current study, we determined that the TOT success rates were not affected by the presence of menopause.

摘要 研究目的：本研究旨在探讨绝经对经闭孔尿道中段悬吊术（transobturator tape, TOT）长期预后的影响。材料与方法：将接受经闭孔尿道中段悬吊术的患者分为绝经后组与绝经前组两组进行评估。患者分别于术后1年及5年随访时填写国际尿失禁咨询委员会简化问卷（International Consultation on Incontinence short-form questionnaire, ICIQ-SF）、尿失禁影响问卷（Incontinence Impact Questionnaire, IIQ-7）及泌尿生殖道痛苦问卷简化版（Urogenital Distress Inventory-Short Form, UDI-6）。将术后UDI-6与IIQ-7评分<10的患者判定为治愈，术后评分较术前降低者判定为症状改善，术后评分高于术前者判定为经闭孔尿道中段悬吊术失败。对比基于UDI-6与IIQ-7所得的经闭孔尿道中段悬吊术成功率。结果：本研究共纳入109例患者，其中绝经后组53例，绝经前组56例。术后1年随访时共随访到90例患者（绝经前组48例，绝经后组42例），术后5年随访时共随访到80例患者（绝经前组44例，绝经后组36例）。术前与术后1年随访时，三项问卷评分均较术前显著改善：ICIQ-SF评分（15.5±2.5 vs. 1.8±4.3，p<0.001）、IIQ-7评分（68.9±9.8 vs. 2.75±15.2，p<0.001）、UDI-6评分（27.1±11.1 vs. 6.0±14.6，p<0.001）；术前与术后5年随访时，三项问卷评分同样均较术前显著改善：ICIQ-SF评分（15.5±2.5 vs. 3.1±5.3，p<0.001）、IIQ-7评分（68.9±9.8 vs. 9.6±26.7，p<0.001）、UDI-6评分（27.1±11.1 vs. 5.1±10.0，p<0.001）。对比绝经前与绝经后患者的复发性尿路感染（recurrent urinary tract infection, UTI）发生情况：术后1年随访时，绝经后组有5例（12%）出现复发性尿路感染，绝经前组无相关病例，组间差异具有统计学意义（p=0.039）；术后5年随访时，绝经后组仍有5例（13.9%）出现复发性尿路感染，绝经前组无相关病例，组间差异同样具有统计学意义（p=0.045）。以UDI-6（术后1年：p=0.198，术后5年：p=0.687）与IIQ-7（术后1年：p=0.489，术后5年：p=0.608）问卷评估，绝经前与绝经后患者的经闭孔尿道中段悬吊术成功率在术后1年及5年随访时均无显著差异。结论：本研究的长期随访结果表明，经闭孔尿道中段悬吊术是一种有效且可靠的治疗方法。本研究证实，绝经状态不会影响经闭孔尿道中段悬吊术的成功率。