Meyer F, Hermieu J F, Boyd A, Dominique S, Peyrat L, Haab F, Ravery V
Department of Urology, Bichat Hospital, Paris, France.
Int Urogynecol J. 2013 May;24(5):817-22. doi: 10.1007/s00192-012-1941-6. Epub 2012 Sep 14.
The aim of the study was to assess the effectiveness of repeat mid-urethral sling after a failed primary sling for stress urinary incontinence.
A total of 112 women with recurrent stress incontinence after primary mid-urethral sling underwent a repeat procedure between 2000 and 2011. All patients had a preoperative clinical and urodynamic evaluation. Outcomes were divided into three groups: cured (no more leaks), improved (decrease of leaks), or failed.
All patients had urethral hypermobility and 12.9 % had intrinsic sphincter deficiency [maximum urethral closure pressure (MUCP) ≤ 20 cmH2O]. Median MUCP was 41 cmH20. Overactive bladder was found in 5.7 % of women. The second sling placed was one of the following: retropubic Tension-free Vaginal Tape (49 %), transobturator tape (48 %), or mini-sling (3 %). No intraoperative morbidity was reported. After the second sling was placed, 68 (60.7 %) patients were subjectively cured and 18 (16.1 %) improved (76.8 % success overall) with a mean follow-up of 21 months. Success rates were 72.2 and 81.8 % for transobturator and retropubic slings, respectively, with no significant difference. Multivariable analysis showed higher odds of cure and improvement with the retropubic approach after adjusting for MUCP. Late complication rates were comparable to those observed after a first sling. Urodynamic parameters were not associated with postoperative success.
Repeat mid-urethral sling for recurrent female stress urinary incontinence is nearly 77 % successful in a group of patients with persistent urethral hypermobility. A retropubic approach might be preferred for patients with low urethral closure pressures.
本研究旨在评估初次尿道中段悬吊带术治疗压力性尿失禁失败后再次进行该手术的有效性。
2000年至2011年间，共有112例初次尿道中段悬吊带术后复发性压力性尿失禁的女性接受了再次手术。所有患者术前均进行了临床和尿动力学评估。结果分为三组：治愈（无漏尿）、改善（漏尿减少）或失败。
所有患者均存在尿道活动过度，12.9%的患者存在固有括约肌缺陷[最大尿道闭合压（MUCP）≤20 cmH₂O]。MUCP中位数为41 cmH₂O。5.7%的女性存在膀胱过度活动症。第二次放置的悬吊带为以下类型之一：耻骨后无张力阴道吊带（49%）、经闭孔吊带（48%）或迷你吊带（3%）。未报告术中并发症。第二次悬吊带放置后，68例（60.7%）患者主观上治愈，18例（16.1%）患者改善（总体成功率为76.8%），平均随访21个月。经闭孔吊带和耻骨后吊带的成功率分别为72.2%和81.8%，无显著差异。多变量分析显示，在调整MUCP后，耻骨后手术方式治愈和改善的几率更高。晚期并发症发生率与初次悬吊带术后观察到的相当。尿动力学参数与术后成功率无关。
对于一组持续存在尿道活动过度的复发性女性压力性尿失禁患者，再次进行尿道中段悬吊带术的成功率接近77%。对于尿道闭合压较低的患者，耻骨后手术方式可能更可取。
