Lee Joseph K-S, Dwyer Peter L, Rosamilia Anna, Lim Yik N, Polyakov Alexander, Stav Kobi
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Int Urogynecol J. 2013 Jan;24(1):47-54. doi: 10.1007/s00192-012-1844-6. Epub 2012 Jun 22.
De novo urgency has a negative impact on women after midurethral sling (MUS). We aimed to identify risk factors for de novo urgency (dU) and urgency urinary incontinence (dUUI) following MUS, using multivariate analysis.
We investigated 358 consecutive women with only stress urinary incontinence (SUI) [or urodynamic stress incontinence (USI)] and 598 women with both SUI (or USI) and urgency (but not UUI) who underwent MUS with a mean follow-up of 50 months. Women who developed dU or dUUI at long-term follow-up were compared to those who did not.
dU occurred in 27.7 % (99/358) and dUUI occurred in 13.7 % (82/598) of women at long-term follow-up after midurethral sling. Intrinsic sphincter deficiency {odds ratio (OR) dU 3.94 [95 % confidence interval (CI) 1.50-10.38]; OR dUUI 2.5 (1.31-4.80)}, previous stress incontinence surgery [sling: OR dU 3.69 (1.45-9.37); colposuspension: OR dUUI 2.5 (1.23-5.07)], previous prolapse surgery [OR dU 2.45 (1.18-5.10)], preexisting detrusor overactivity [OR dU 1.99 (1.15-3.48); OR dUUI 1.85 (1.31-2.60)] increased the risk, whereas performing concomitant apical prolapse surgery [OR dU 0.5 (0.41-0.81); OR dUUI 0.29 (0.087-0.97)] significantly decreased the risk. Women are more likely to not recommend surgery when they experienced dU (18.2 vs 0.8 %, p < 0.0001) or dUUI (20.7 vs 2.1 %, p < 0.0001).
Urodynamic parameters, history of prior incontinence or prolapse surgery and concomitant apical prolapse operation were important predictors of dU or dUUI following MUS.
新发尿急对接受尿道中段吊带术（MUS）的女性有负面影响。我们旨在通过多变量分析确定MUS术后新发尿急（dU）和急迫性尿失禁（dUUI）的危险因素。
我们调查了358例仅患有压力性尿失禁（SUI）[或尿动力学压力性尿失禁（USI）]的女性以及598例同时患有SUI（或USI）和尿急（但无急迫性尿失禁）且接受了MUS的女性，平均随访50个月。将长期随访中出现dU或dUUI的女性与未出现的女性进行比较。
在尿道中段吊带术后的长期随访中，27.7%（99/358）的女性出现了dU，13.7%（82/598）的女性出现了dUUI。固有括约肌功能不全{比值比（OR）dU为3.94[95%置信区间（CI）1.50 - 10.38]；OR dUUI为2.5（1.31 - 4.80）}、既往压力性尿失禁手术[吊带术：OR dU为3.69（1.45 - 9.37）；膀胱颈悬吊术：OR dUUI为2.5（1.23 - 5.07）]、既往盆腔器官脱垂手术[OR dU为2.45（1.18 - 5.10）]、既往存在逼尿肌过度活动[OR dU为1.99（该文有误，应为1.99（1.15 - 3.48），原文多了一个分号；OR dUUI为1.85（1.31 - 2.60）]会增加风险，而同期进行顶端脱垂手术[OR dU为0.5（0.41 - 0.81）；OR dUUI为0.29（0.087 - 0.97）]则显著降低风险。经历过dU（18.2%对0.8%，p < 0.0001）或dUUI（20.7%对2.1%，p < 0.0001）的女性不太可能推荐手术。
尿动力学参数、既往尿失禁或盆腔器官脱垂手术史以及同期顶端脱垂手术是MUS术后dU或dUUI的重要预测因素。
