Incontinence outcomes after "second primary" compared to repeat midurethral sling for recurrent and persistent stress urinary incontinence.
Incontinence outcomes after "second primary" compared to repeat midurethral sling for recurrent and persistent stress urinary incontinence.
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DOI：
10.1007/s00192-020-04447-6
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发表时间：
2021-01
影响因子：
1.8
通讯作者：
Richter HE
中科院分区：
文献类型：
--
作者：
Melnikoff AK;Meyer I;Martin KD;Richter HE
本研究旨在评估吊带切除术后复发性/持续性压力性尿失禁（SUI）女性的“第二原发性”尿道中段吊带（MUS）的复律率，并与接受重复MUS的历史队列进行比较。2016年与2006-2009年重复MUS的历史队列相比。主要结局是复发率，定义为“完全没有”或“有点”泌尿生殖器窘迫量表（UDI-6）SUI子量表问题。次要结局包括症状严重程度评估（UDI-6）、症状特异性生活质量、健康影响问卷（IIQ-7）、老龄化医学和流行病学方面（梅萨）和患者总体改善印象（PGI-I）。“第二主要”MUS组中有23/64（36%）的调查答复，而历史队列中有88/135（65%）。平均随访月数，第二次主要：41.8 ± 26.1 vs重复：36.2 ± 14.1，p=0.16，年龄（岁）：56.4 ± 10.7 vs 59.8 ± 10.8，p=0.19。第二原发组的尿失禁率为48%，重复组为56%（p=0.50）。两组术后问卷评分均显著改善，组间无差异。多变量分析表明，两组之间的成功几率没有差异（调整后的比值比：0.73，95%置信区间：0.27-1.99）。在复发性/持续性SUI的女性中，重复和“第二原发性”MUS在UI症状困扰和QOL方面表现出相似的成功结局和改善。对于这一日益重要的临床问题，需要继续进行研究。在复发性/持续性SUI的女性中，重复和“第二原发性”MUS在尿失禁症状困扰和生活质量方面表现出相似的成功结局和改善。
The current study aims to assess the continence rate of a “second primary” midurethral sling (MUS) in women with recurrent/persistent stress urinary incontinence (SUI) after sling excision compared to a historical cohort who underwent a repeat MUS. A retrospective cohort study of women who underwent excision of a primary MUS and placement of a “second primary” MUS from 2009–2016 compared to a historical cohort who underwent a repeat MUS from 2006–2009. The primary outcome was continence rate, defined as “not at all” or “somewhat” to Urogenital Distress Inventory (UDI-6) SUI subscale questions. Secondary outcomes included assessment of symptom severity (UDI-6), symptom specific quality of life, Incontinence Impact Questionnaire (IIQ-7), Medical and Epidemiologic Aspects of Aging (MESA), and Patient Global Impression of Improvement (PGI-I). Survey responses were available for 23/64 (36%) in the “second primary” MUS group versus 88/135 (65%) in the historical cohort. Mean follow-up in months, second primary: 41.8 ± 26.1 versus repeat: 36.2 ± 14.1, p=0.16 and age (years): 56.4 ± 10.7 versus 59.8 ± 10.8, p=0.19. Continence rates were 48% in “second primary” versus 56% in the repeat group (p=0.50). Both groups had significant improvement in questionnaire scores postoperatively with no intergroup differences. Multivariable analysis demonstrated that odds of success did not differ between groups (adjusted odds ratio: 0.73, 95% confidence interval: 0.27–1.99). In women with recurrent/persistent SUI, repeat and “second primary” MUS demonstrate similar success outcomes and improvement in UI symptom distress and QOL. Continued research is needed for this increasingly important clinical question. In women with recurrent/persistent SUI, repeat and “second primary” MUS demonstrate similar success outcomes and improvement in urinary incontinence symptom distress and quality of life.
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