女性行初次和再次经阴道中段吊带术的尿失禁结局。
Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures.
机构信息
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
Obstet Gynecol. 2013 Feb;121(2 Pt 1):273-278. doi: 10.1097/AOG.0b013e31827c5de7.
OBJECTIVE
To assess stress urinary incontinence (SUI) and other lower urinary tract symptom outcomes in women undergoing repeat midurethral sling procedures compared with those undergoing primary midurethral sling procedures.
METHODS
Cure was defined as responses of "not at all" or "somewhat" to both questions of the SUI subscale of the Urogenital Distress Inventory-6; symptom effect was assessed using the Incontinence Impact Questionnaire-7. Multivariable models were created controlling for baseline Medical Epidemiologic and Social Aspects of Aging questionnaire urge score and Urogenital Distress Inventory-6 stress subscale score.
RESULTS
One thousand three hundred sixteen patients had charts available for review: 135 of 1,316 (10.2%) had undergone prior midurethral sling procedures; 799 of 1,316 (61%) questionnaires were returned, with 92 from those having undergone prior midurethral sling procedures. Median follow-up time was 36.4 months with a range of 11.4-71.5 months. Cure rates were 71% (95% confidence interval [CI] 67.7-74.3%) in the primary midurethral sling group and 54% (95% CI 43.8-64.2%) in the repeat midurethral sling group (P<.001). Women undergoing repeat midurethral sling procedures experienced significantly greater improvement in symptom-specific quality of life (QOL) compared with those undergoing primary midurethral sling procedures (-28.87±37.6 compared with -18.42±32.73, P=.01). Multivariable analyses revealed that women in the repeat midurethral sling group had increased risk of SUI failure (odds ratio 1.7, 95% CI 1.1-2.8).
CONCLUSION
Women undergoing repeat midurethral sling procedures had almost two times the odds of SUI treatment failure but greater improvement in symptom effect on QOL than did those undergoing a primary midurethral sling procedure. This information can help counsel patients regarding their expectations of repeat midurethral sling surgery for recurrent SUI .
LEVEL OF EVIDENCE
II.
目的
评估与初次经尿道中段吊带术（midurethral sling procedures，MUS）相比，重复经尿道中段吊带术（repeat MUS）治疗女性压力性尿失禁（stress urinary incontinence，SUI）及其他下尿路症状的效果。
方法
治愈定义为尿失禁亚量表（Urogenital Distress Inventory-6）中两个问题的回答均为“一点也不”或“有些”；症状效果采用尿失禁影响问卷-7（Incontinence Impact Questionnaire-7）进行评估。采用多变量模型，控制基线医学生物学及社会老龄化调查量表（Medical Epidemiologic and Social Aspects of Aging questionnaire，MESA）急迫评分和尿失禁窘迫量表（Urogenital Distress Inventory-6，UDI-6）压力亚量表评分。
结果
共 1316 例患者的病历可供查阅，其中 135 例（10.2%）曾行 MUS，799 例（61%）患者完成问卷，92 例（61%）来自曾行 MUS 患者。中位随访时间为 36.4 个月（范围：11.4-71.5 个月）。初次 MUS 组的治愈率为 71%（95%置信区间[confidence interval，CI]：67.7%-74.3%），重复 MUS 组为 54%（95%CI：43.8%-64.2%）（P<.001）。与初次 MUS 组相比，重复 MUS 组患者的 SUI 相关生活质量（symptom-specific quality of life，SUI-QOL）显著改善（-28.87±37.6 比-18.42±32.73，P=.01）。多变量分析显示，重复 MUS 组患者发生 SUI 治疗失败的风险增加（比值比[odds ratio，OR]：1.7，95%CI：1.1-2.8）。
结论
与初次 MUS 相比，重复 MUS 患者发生 SUI 治疗失败的风险几乎增加 2 倍，但 SUI-QOL 症状改善更明显。这些信息有助于患者了解重复 MUS 治疗复发性 SUI 的预期效果。
证据等级
II 级。
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