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La histerectomía y la incontinencia urinaria: una revisión sistemática
J S Brown1, G Sawaya, D H Thom
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA. brownj@obgyn.ucsf.edu
Lancet (London, England)
|August 19, 2000
Resumen
La histerectomía puede aumentar el riesgo de incontinencia urinaria, particularmente en mujeres de 60 años o más. Discutir esta posible complicación a largo plazo durante el asesoramiento es crucial para las decisiones informadas del paciente.
Área de la Ciencia:
- Ginecología Ginecología.
- Urología Urología Urología.
- La medicina basada en la evidencia es la medicina basada en la evidencia.
Sus antecedentes:
- La histerectomía es un procedimiento ginecológico común.
- Las complicaciones graves ocurren en aproximadamente 6 de cada 10.000 histerectomías.
- Una posible asociación con la incontinencia urinaria merece una investigación.
Objetivo del estudio:
- Revisar sistemáticamente las pruebas que vinculan la histerectomía a la incontinencia urinaria.
- Para cuantificar el riesgo de desarrollar incontinencia después de la histerectomía.
Principales métodos:
- Revisión sistemática de artículos en inglés y no en inglés de MEDLINE (1966-1997) y listas de referencias.
- La inclusión de estudios que informan datos originales sobre el desarrollo de la incontinencia después de la histerectomía.
- Abstracción de datos por dos revisores independientes y metanálisis utilizando un modelo de efectos aleatorios.
Principales resultados:
- 12 estudios (8 transversales, 2 cohorte, 1 caso control, 1 ECA) cumplieron con los criterios de inclusión.
- En general, la histerectomía se asoció con un aumento de las probabilidades de incontinencia urinaria.
- Las mujeres mayores de 60 años mostraron un 60% más de probabilidades (OR 1.6) de incontinencia, mientras que las mujeres más jóvenes no mostraron mayores probabilidades.
Conclusiones:
- La histerectomía se asocia con una mayor probabilidad de incontinencia urinaria, especialmente en mujeres mayores.
- Esta secuela potencial debe ser discutida durante el asesoramiento de la paciente con respecto a la histerectomía.
- El riesgo de incontinencia puede manifestarse años después del procedimiento, lo que resalta la importancia de las discusiones de seguimiento a largo plazo.
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