Safety and Efficacy of Sling for Persistent Stress Urinary Incontinence After Bulking Injection
Safety and Efficacy of Sling for Persistent Stress Urinary Incontinence After Bulking Injection
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DOI：
10.1016/j.urology.2010.10.010
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发表时间：
2011-05-01
期刊：
影响因子：
2.1
通讯作者：
Dmochowski, Roger R.
中科院分区：
文献类型：
--
作者：
Koski, Michelle E.;Enemchukwu, Ekene A.;Dmochowski, Roger R.
目的 评估注射剂对后续失禁手术结果的影响，以评估该治疗组合的安全性和有效性。尿道周围填充剂是压力性尿失禁 (SUI) 的微创治疗选择，但通常缺乏持久性，需要进一步手术干预。方法对 2000 年 11 月至 2009 年 9 月期间接受后续吊带放置的 43 名 SUI 患者进行回顾性评估，评估其人口统计学、症状、尿动力学 (UDS)、填充剂特性、伴随手术、每日尿垫需求 (PPD)、主观结果和并发症。结果 患者平均年龄为 67 岁，平均随访时间为 37.3 个月。所有患者均出现 SUI，其中 81.4% 出现混合性尿失禁 (MUI)。近一半（48.8%）之前接受过抗失禁手术。平均注射次数为 3 次。大量注射后，放置 25 个自体筋膜耻骨阴道吊带、13 个尿道中段吊带和 5 个生物耻骨阴道吊带。 37.2% 的患者同时进行了盆腔手术。术后，平均 PPD 从 5.3 降至 0.65，主观治愈率为 60.5%（在任何情况下均无护垫或渗漏）。注射次数、类型或吊带类型与患者预后之间没有关联。结果与伴随手术显着相关 (P = .007)。 8 名患者 (18.6%) 复发 SUI，与其他参数没有统计学相关性。并发症包括尿潴留（8 名患者）、新发尿急（1 名患者）、尿路感染（4 名患者）、腹部伤口感染（3 名患者）和膀胱切开术（1 名患者）。 结论 在我们的患者群体中，先前使用填充剂治疗似乎不会对未来抗失禁手术的结果产生负面影响。泌尿学 77: 1076-1080, 2011。(C) 2011 Elsevier Inc.
OBJECTIVES To evaluate the impact of injectable agents on subsequent incontinence surgery outcomes to assess safety and efficacy of this treatment combination. Periurethral bulking agents are a minimally invasive treatment option for stress urinary incontinence (SUI), but often lack durability necessitating further surgical intervention.METHODS Retrospective review of 43 patients with SUI following bulking agent who underwent subsequent sling placement from November 2000 to September 2009 were evaluated for demographics, symptoms, urodynamics (UDS), bulking agent characteristics, concomitant procedures, pad requirements per day (PPD), subjective outcomes, and complications.RESULTS Mean patient age was 67 years, with mean follow-up of 37.3 months. All demonstrated SUI, and mixed urinary incontinence (MUI) was noted in 81.4%. Almost half (48.8%) had undergone a prior antiincontinence procedure. Mean number of injections was 3. After a bulking injection, 25 autologous fascia pubovaginal slings, 13 midurethral slings, and 5 biological pubovaginal slings were placed. Concomitant pelvic surgery was performed in 37.2%. Postoperatively, mean PPD decreased from 5.3 to 0.65, with a 60.5% subjective cure rate (no pads or leakage under any circumstances). No association was seen between number or type of injection, or type of sling with regards to patient outcomes. Results were significantly related to concomitant surgery (P = .007). SUI recurred in 8 patients (18.6%), which was not statistically associated with other parameters. Complications included urinary retention (8 patients) de novo urgency (1 patient), UTI (4 patients), abdominal wound infection (3 patients), and cystotomy (1 patient).CONCLUSIONS Prior treatment with bulking agents does not appear to negatively affect outcomes for future antiincontinence surgery in our patient population. UROLOGY 77: 1076-1080, 2011. (C) 2011 Elsevier Inc.