目的:确定神经泌尿外科患者与不同膀胱管理策略相关的总体生活质量和患者满意度。第二个目标是确定可能进一步影响患者生活质量的其他相关因素。
方法:系统评价。
方法:来自Pubmed,科克伦,谷歌学者数据库是使用与“生活质量”相关的术语提取的,\'满意\',在“神经源性膀胱”结合“膀胱管理方法”中,包括“大陆和非大陆尿液改道”,\'间歇性导管插入术\',“留置导管”和“避孕套导管”。仅包括80%的神经源性膀胱患者的最小比例的研究。进行了搜索,并对文章标题和摘要进行了评级。对136篇论文进行了筛选和资格评估。
结果:25项研究纳入最终分析,包括10项回顾性研究,九个潜在的,五项横断面和一项随机对照试验。总的来说,包括3002名患者,以男性(55%)和脊髓损伤(88%)患者居多。167例尿失禁尿路改道,464例出现大陆尿路改道(膀胱增大伴或不伴皮肤导管通道),1698使用间歇性导管插入术(自行或由服务员),550有留置导管(尿道或耻骨上),123有避孕套导管。使用多种验证和未验证的问卷评估生活质量。总的来说,大陆和失禁转移的患者往往有更好的分数。导管的使用往往有更不令人满意的分数,留置和伴随间歇性导管插入通常得分更差。另一方面,使用自我间歇导尿的患者倾向于正常。
结论:正常排尿后自行导尿可获得更高的整体生活质量。数据差异太大,无法对其他膀胱管理方法进行排名。然而,通过改善节制,每种方法都旨在提高生活质量。
OBJECTIVE: To determine the overall quality of life and patient satisfaction associated with different bladder management strategies in neuro-urological patients. The second objective was to identify other associated factors that may further influence the patient\'s quality of life.
METHODS: Systematic Review.
METHODS: Studies from Pubmed, Cochrane, and Google Scholar databases were extracted using terms relating to \'quality of life\', \'satisfaction\', in \'neurogenic bladder\' combined with \'bladder management methods\' that included \'continent and non-continent urine diversion\', \'intermittent-catheterization\', \'indwelling catheter\' and \'condom-catheter\'. Only studies with a minimal proportion of 80% of neurogenic bladder patients were included. Search was conducted, and article titles and abstracts were rated. 136 papers were screened and assessed for eligibility.
RESULTS: 25 studies were included in the final analysis and consisted of ten retrospective, nine prospective, five cross-sectional and a single randomized controlled trial. In total, 3002 patients were included, with a majority of male (55%) and spinal cord injury (88%) patients. 167 patients had incontinent urinary diversions, 464 had continent urinary diversions (bladder augmentation with or without cutaneous catheterizable channel), 1698 used intermittent catheterization (self or by an attendant), 550 had an indwelling catheter (urethral or suprapubic), and 123 had condom catheters. Quality of life was assessed using a wide variety of validated and non-validated questionnaires. Overall, patients with continent and incontinent diversion tended to have better scores. Use of catheters tended to have more unsatisfactory scores, with indwelling and attendant-intermittent catheterization often scoring worse. On the other hand, patients using self-intermittent catheterization tended to fair well.
CONCLUSIONS: Normal micturition followed by self-catheterization yielded an overall higher quality of life. Data were too divergent to rank the other bladder management methods. However, by improving continence, each method aims to enhance quality of life.