Long-Term Outcomes After Midurethral Mesh Sling Surgery for Stress Urinary Incontinence.
Long-Term Outcomes After Midurethral Mesh Sling Surgery for Stress Urinary Incontinence.
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DOI：
10.1097/spv.0000000000001094
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发表时间：
2022-04-01
影响因子：
1.6
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中科院分区：
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虽然尿道中段网片悬吊术是压力性尿失禁（SUI）的金标准手术，但关于长期结局的数据有限。因此，我们的目标是评估吊带翻修的长期风险和初次吊带后15年内重复SUI手术的风险，并确定这些结果的预测因素。使用美国商业保险个人的人口队列，我们确定了2001年至2018年期间接受吊带手术的≥ 18岁女性。对于吊带翻修，我们评价了适应症（补片暴露或尿潴留）。我们使用Kaplan-Meier生存曲线估计每年吊带翻修和重复SUI手术的累积风险，并使用考克斯比例风险模型评估预测因子。我们确定了334，601例网状吊带手术。对于吊带翻修，10年和15年风险分别为6.9%（95% CI：6.7-7.0）和7.9%（95% CI：7.5-8.3），48.7%的吊带翻修与补片暴露相关。再次SUI手术的10年和15年风险分别为14.5%（95% CI：14.2-14.8）和17.9%（95% CI：17.3-18.6）。与70岁及以上的女性相比，18-29岁的女性进行吊带翻修（HR 1.20，95%CI：1.15-1.25）和重复SUI手术（HR 1.30，95%CI：1.25-1.37）的风险升高。在我们的研究人群中，吊带翻修的15年风险为7.9%，近一半的翻修是由于补片暴露。这些研究结果提供了关键的长期数据，以支持妇女和提供者考虑尿道中段网状吊带的明智决定。
Although midurethral mesh slings are the gold standard surgery for stress urinary incontinence (SUI), limited data exist regarding long-term outcomes. Thus, our objectives were to evaluate the long-term risk of sling revision and the risk of repeat SUI surgery up to 15 years after the initial sling and to identify predictors of these outcomes. Using a population-based cohort of commercially-insured individuals in the U.S., we identified women aged ≥ 18 who underwent a sling procedure between 2001 and 2018. For sling revision, we evaluated indications (mesh exposure or urinary retention). We estimated the cumulative risks of sling revision and repeat SUI surgery annually using Kaplan-Meier survival curves and evaluated predictors using Cox proportional hazards models. We identified 334,601 mesh sling surgeries. For sling revision, the 10- and 15-year risks were 6.9% (95% CI: 6.7-7.0) and 7.9% (95% CI: 7.5-8.3), with 48.7% of slings revisions associated with mesh exposure. The 10- and 15-year risks of repeat SUI surgery were 14.5% (95% CI, 14.2-14.8) and 17.9% (95% CI: 17.3-18.6). Women aged 18-29 had an elevated risk for both sling revision (HR 1.20, 95%CI: 1.15-1.25) and repeat SUI surgery (HR 1.30, 95%CI: 1.25-1.37) compared to women 70 years and older. In our study population, the 15-year risk of sling revision was 7.9%, with nearly half of revisions due to mesh exposure. These findings provide critical long-term data to support informed decisions for women and providers considering midurethral mesh slings.