Repeat Synthetic Mid Urethral Sling Procedure for Women With Recurrent Stress Urinary Incontinence
Repeat Synthetic Mid Urethral Sling Procedure for Women With Recurrent Stress Urinary Incontinence
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DOI：
10.1016/j.juro.2009.08.111
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发表时间：
2010-01-01
影响因子：
6.6
通讯作者：
Lee, Joseph
中科院分区：
文献类型：
--
作者：
Stav, Kobi;Dwyer, Peter L.;Lee, Joseph
目的：我们报告和比较的结果，重复尿道中段吊带与初级尿道中段吊带在妇女压力性尿incontinent.Materials和方法：一个连续的1,225名妇女与尿动力学压力性尿失禁进行了合成尿道中段吊带程序（955耻骨后，270 transobturator）在我们的机构在1999年和2007年之间。91%（1，112）的患者通过电话接受了结构化问卷调查，并被纳入分析。平均+/- SD随访时间为50 +/- 24个月（范围12 - 114）。重复组（77例，平均年龄62 +/- 12岁）和初次组（1,035例，平均年龄60 +/- 13岁）尿道中段悬吊组进行了比较。结果：重复尿道中段悬吊术的患者术前内括约肌功能障碍的发生率较高（31%比13%，P < 0.001）。初次和再次手术组的主观压力性尿失禁治愈率分别为86%和62%（p < 0.001）。重复耻骨后入路的成功率显著高于重复经闭孔肌入路（71% vs 48%，p = 0.04）。初次组和重复组的吊带相关和一般术后并发症发生率相似。然而，在重复组中，原发性尿急（30%vs14%，p < 0.001）和原发性急迫性尿失禁（22%vs5%，p < 0.001）的发生率高于初次组。重复耻骨后入路的成功率高于重复经闭孔肌入路。在重复手术中，新发尿急和急迫性尿失禁的发生率明显更高。
Purpose: We reported and compared the outcomes of repeat mid urethral sling with primary mid urethral sling in women with stress urinary incontinence.Materials and Methods: A total of 1,225 consecutive women with urodynamic stress incontinence underwent a synthetic mid urethral sling procedure (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Of the patients 91% (1,112) were interviewed via telephone call with a structured questionnaire and were included in the analysis. Mean +/- SD followup was 50 +/- 24 months (range 12 to 114). A comparison between repeat (77, mean age 62 +/- 12 years) and primary (1,035, mean age 60 +/- 13 years) mid urethral sling groups was performed. Repeat sling was placed without removal of the previous sling.Results: The preoperative incidence of intrinsic sphincter deficiency was higher in patients who had a repeat mid urethral sling (31% vs 13%, p < 0.001). The subjective stress incontinence cure rate was 86% and 62% in the primary and repeat group, respectively (p < 0.001). The repeat retropubic approach was significantly more successful than the repeat transobturator approach (71% vs 48%, p = 0.04). The rates of sling related and general postoperative complications were similar between the primary and the repeat groups. However, de novo urgency (30% vs 14%, p < 0.001) and de novo urge urinary incontinence (22% vs 5%, p < 0.001) were more frequent in the repeat group compared with the primary group.Conclusions: A repeat synthetic mid urethral sling procedure has a significantly lower cure rate than a primary mid urethral sling procedure. The repeat retropubic approach has a higher success rate than the repeat transobturator approach. The incidence of de novo urgency and urge incontinence are significantly higher in repeat procedures.