Molden Stephanie, Bracken Jessica, Nguyen Aimee, Harvie Heidi S, White Amanda, Hammil Sarah L, Patterson Danielle, Tarr Megan, Sanses Tatiana, Murphy Miles, Rogers Rebecca G
From the *Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; †Scott & White, Temple, TX; ‡Evanston Northshore Hospital, Evanston, IL; §University of Pennsylvania, Philadelphia, PA; ∥University of Texas Southwestern Medical Center, Dallas, TX; ¶University of New Mexico, Albuquerque, NM; #Brigham and Women's Hospital, Boston, MA; **Loyola University, Chicago, IL; and ††Greater Baltimore Medical Center, Baltimore, MD.
Female Pelvic Med Reconstr Surg. 2010 Nov;16(6):340-4. doi: 10.1097/SPV.0b013e3181f5ac07.
: The purpose of this study was to determine outcomes of sling revision after midurethral sling (MUS) placement and whether timing of sling revision affected those outcomes.
: This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence.
: One hundred seventy-five patients who met the study criteria had complete data. Overall, 70% (133) of MUS were retropubic and 30% (56) were obturator slings. Midurethral sling revision was accomplished by cutting (54%), excision (29%), and pulling down on the mesh (18%). Stress urinary incontinence (SUI) resolved in 38%, urinary tract infections (UTIs) in 69%, and overactive bladder (OAB) in 75%. In comparison, 21% experienced de novo SUI; 18%, de novo UTIs; and 12%, de novo OAB symptoms after revision. Voiding dysfunction resolved in 80%, however 10% experienced new voiding dysfunction symptoms. Retropubic slings displayed more voiding dysfunction, higher de novo/worsened OAB, and more UTIs after revision than obturator slings. Sling revision timing did not predict persistent voiding dysfunction but did predict SUI with earlier revision (≤2 weeks) resulting in less postrevision SUI when compared to revisions at 15-90 days or greater than 90 days. The method of sling revision (cut, excised, pulled down) did not predict SUI, OAB, or obstructive voiding symptoms.
: Sling revision resolves voiding dysfunction symptoms, UTIs and post-sling OAB symptoms in the majority of patients. Resolution of voiding dysfunction is independent of method and timing of revision; however earlier revision is associated with decreased postrevision SUI.
本研究的目的是确定经尿道中段吊带术（MUS）置入后吊带修复的结果，以及吊带修复的时机是否会影响这些结果。
这是一项多中心研究，纳入了因排尿功能障碍接受MUS置入及随后吊带修复的患者。对所有有完整数据的吊带修复患者，比较吊带修复前后的诊断结果。进行逻辑回归分析，以确定修复时机是否可预测排尿功能障碍和压力性尿失禁。
175名符合研究标准的患者有完整数据。总体而言，70%（133例）的MUS为耻骨后吊带，30%（56例）为闭孔吊带。经尿道中段吊带修复通过切割（54%）、切除（29%）和下拉网片（18%）完成。压力性尿失禁（SUI）缓解率为38%，尿路感染（UTIs）为69%，膀胱过度活动症（OAB）为75%。相比之下，21%出现新发SUI；18%，新发UTIs；12%，修复后出现新发OAB症状。排尿功能障碍缓解率为80%，然而10%出现新的排尿功能障碍症状。与闭孔吊带相比，耻骨后吊带修复后显示出更多的排尿功能障碍、更高的新发/加重OAB以及更多的UTIs。吊带修复时机不能预测持续性排尿功能障碍，但可预测SUI，与15 - 90天或大于90天进行修复相比，早期修复（≤2周）导致修复后SUI较少。吊带修复方法（切割、切除、下拉）不能预测SUI、OAB或梗阻性排尿症状。
吊带修复可使大多数患者的排尿功能障碍症状、UTIs和吊带术后OAB症状得到缓解。排尿功能障碍的缓解与修复方法和时机无关；然而，早期修复与修复后SUI减少相关。
