女性應力性尿失禁病人接受經閉孔尿道中段懸吊手術之成效

與生物電阻抗分析定義之肌少症的關係

江長和¹、范玉華 ^1,2、林登龍^1,2、顧明軒^1,2、黃志賢^1,2

¹臺北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科 書田泌尿科學研究中心

Association with outcomes of trans-obturator mid-urethral slings in female stress urinary incontinence patients and sarcopenia defined by bioelectrical inpedance analysis

Chang-Ho Chiang¹, Yu-Hua Fan^1,2, Teng-Lung Lin^1,2,Ming-Hsuan Ku ^1,2,

 William J. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Sarcopenia is defined as an age associated decline in skeletal muscle mass. Sarcopenia at the level of the pelvic floor muscles is of special importance in the aging woman as it may contribute to stress urinary incontinence (SUI). Nevertheless, limited literature investigated the association between the outcomes of trans-obturator mid-urethral slings in female SUI and sarcopenia. This study aimed to investigate the association between sarcopenia and the outcomes of SUI patients undergoing trans-obturator mid-urethral sling surgery.

Materials and Methods:

We prospectively enrolled the female patients with lower urinary tract symptoms who visited urological outpatient clinic at Taipei Veterans General Hospital from January 2021 to June 2023. Lower urinary tract symptoms were recorded with Overactive Bladder Symptom Score(OABSS), International Prostate Symptom Score (IPSS), Urinary Distress Inventory, Short Form( UDI-6). SUI symptoms and quality of life were assessed using the Symptom Severity Index and Symptom Impact Index for Stress Incontinence questionnaire(IIQ7). Videourodynamic study including a valsalva leak point pressure (VLPP) test was also done before sling surgery. Body composition analysis through bioelectrical impedance analysis (BIA) was performed with InBody 770 (Biospace, Seoul, Korea). Nowadays, the common definition of sarcopenia included skeletal muscle mass ratio(SMR) to body weight <27.6%, appendicular skeletal muscle mass(ASM) obtained from BIA < 15 kg or calculated appendicular skeletal muscle mass index(ASM/Height²)< 5.5 kg/m². Additionally, data regarding demographic characteristics and comorbidities were collected. Post-operative clinical data was collected during 3-6 months after sling surgery and included several questionnaires mentioned above: OABSS, IPSS, UDI-6 and IIQ7 . Multivariate logistic regression analyses were conducted to assess the predictive factors of outcome of trans-obturator mid-urethral slings in SUI patients.

Results

In total, 140 patients were enrolled. Among them, 41 patients had at least grade 1 SUI (Grade 1, n= 8; Grade 2, n= 18; Grade 3, n= 12; Grade 4, n= 3). Among SUI patients, 20 patients decided to receive trans-obturator mid-urethral sling surgery. Finally, post-operative clinical assessment questionnaires were collected in 18 patients. Total 3, 6, 5 patients individually matched the different definition of sarcopenia: SMR <27.6%, ASM < 15 kg or ASMI< 5.5 kg/m².

The number of deliveries was significantly higher in patients with sarcopenia (p= 0.014). Moreover, old age (p<0.001), severe IPSS category(p=0.027) were more prevalent in sarcopenia patients. More frequent SUI yearly (p=0.047) occurred in sarcopenia patients was noted via IIQ7 questionnaire.

Regarding the BIA variables, the prevalence of overweight (p= 0.034), body mass index (p= <0.001), fat mass index(p<0.001) were significantly higher in patients with sarcopenia.

There was no significant difference between sarcopenia group and non-sarcopenia group in video urodynamic study and difference analysis of pre-operative and post-operative clinical questionnaires (OABSS, IPSS, UDI-6 and IIQ7) via Chi-squared test, student T test, multivariate logistic regression analyses.

Conclusions

Our study reported that higher delivery number, old age, more severe LUTS and SUI symptom, body mass index and fat mass index were highly correlated to the occurrence of sarcopenia in female SUI patients. Enrolling more SUI patients may aimed to find out the predictive factors of outcome of trans-obturator mid-urethral sling surgery.