Repeat versus primary slings in patients with intrinsic sphincter deficiency
Repeat versus primary slings in patients with intrinsic sphincter deficiency
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DOI：
10.1007/s00192-012-1953-2
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发表时间：
2013-06-01
影响因子：
1.8
通讯作者：
Davila, G. Willy
中科院分区：
文献类型：
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作者：
Smith, Aimee L.;Karp, Deborah R.;Davila, G. Willy
我们的目的是比较重复与初次合成吊带治疗压力性尿失禁（SUI）伴内源性括约肌功能障碍（ISD）患者的结局。我们回顾了2003年至2010年接受吊带治疗SUI伴ISD的患者。根据患者是否接受初次或重复悬吊术，将患者分为两组。手术成功定义为无尿失禁和无再次干预（即，尿道膨胀）。统计学分析包括非配对t检验、Wilcoxon秩和检验、卡方/Fisher精确检验和logistic回归，以确定与失败相关的风险因素。637例ISD患者在我们的机构接受了悬吊术; 557例（87%）初次悬吊术和80例（13%）重复悬吊术。患者人口统计学相似。术前，复发性SUI患者报告更多的主观困扰。平均随访时间为66.5周（24-374）。初次悬吊成功率为81%，重复悬吊成功率为55%（p < 0.0001）。重复手术患者手术失败的可能性高3.4倍[比值比（OR）= 3.43，95%置信区间（CI）2.1-5.6]。此外，30%的重复组患者术后接受了尿道扩张，而初次组为8.6%（OR = 4.4，95%CI 2.5-7.7）。既往尿失禁手术、仰卧位压力试验阳性和经闭孔肌吊带是失败的独立危险因素。在放置的吊带类型（经闭孔、耻骨后、张力耻骨阴道）中，耻骨阴道吊带最成功（OR = 2.7，95%CI 1.4-5.2）。在ISD女性中，与初次吊带相比，重复吊带的成功率较低。耻骨阴道悬吊术的成功率最高，与经闭孔肌悬吊术和耻骨后悬吊术相比。
Our goal was to compare outcomes of repeat vs. primary synthetic slings in patients with stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD).We reviewed patients who underwent a sling for SUI with ISD from 2003 to 2010. The patients were divided into two groups according to whether they underwent primary or repeat sling. Surgical success was defined as no incontinence and no reintervention (i.e., urethral bulking) during follow-up. Statistical analysis included the unpaired t test, Wilcoxon rank sums test, chi-squared/Fisher's exact tests, and logistic regression to identify risk factors associated with failure.Six hundred and thirty-seven patients with ISD underwent a sling procedure at our institution; 557 (87 %) a primary sling and 80 (13 %) a repeat sling. Patient demographics were similar. Preoperatively, patients with recurrent SUI reported more subjective bother. Mean follow-up was 66.5 weeks (24-374). Success was achieved in 81 % of primary compared with 55 % of repeat slings (p < 0.0001). Repeat patients were 3.4 times more likely to fail surgery [odds ratio (OR) = 3.43, 95 % confidence interval (CI) 2.1-5.6]. Additionally 30 % of the repeat group underwent urethral bulking postoperatively compared with 8.6 % in the primary group (OR = 4.4, 95 % CI 2.5-7.7). Prior incontinence procedures, a positive supine stress test, and transobturator sling were independent risk factors for failure. Among the types of slings placed (transobturator, retropubic, tensioned pubovaginal), pubovaginal slings were most successful (OR = 2.7, 95 % CI 1.4-5.2).In women with ISD, repeat slings are associated with lower success rates compared with primary slings. Pubovaginal slings resulted in the highest success rate compared with both transobturator and retropubic slings.