Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Am J Obstet Gynecol. 2016 Feb;214(2):263.e1-263.e8. doi: 10.1016/j.ajog.2015.08.069. Epub 2015 Sep 5.
The synthetic midurethral slings were introduced in the 1990s and were rapidly replaced the Burch colposuspension as the gold standard treatment for urinary incontinence. It has been reported that the retropubic midurethral tape has an objective and subjective cure rate of 85% at 5 years of follow-up, but the rate of reoperation after retropubic midurethral tape at the long-term follow-up is less well described. The existing literature specifies an overall lifetime rate of reoperation of about 8-9% after an initial operation for urinary incontinence. There are, however, conflicting statements about the risk of reoperation after specific surgical procedures for urinary incontinence.
The objective of the study was to describe the cumulative incidence of reoperation within a 5 year period after different types of surgical procedures for urinary incontinence based on a nationwide population.
We used the Danish National Patient Registry to identify women who had surgery for urinary incontinence from 1998 through 2007 and the outcome was a reoperation within 5 years. Kaplan-Meier curves were used to estimate the rate of reoperation for 6 types of surgery for urinary incontinence (retropubic midurethral tape, transobturator tape, urethral injection therapy, Burch colposuspension, pubovaginal slings, and miscellaneous operations). Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for factors suspected to be associated with reoperation.
A total of 8671 women (mean age, 56.1 years, range 6.7-93.7 years) underwent surgical treatment for urinary incontinence. Among these women, 5820 (67%) received a synthetic midurethral sling at baseline. The cumulative incidence of reoperation after any surgical treatment for urinary incontinence was 10%. The lowest rate of reoperation was observed among women having pubovaginal slings (6%), retropubic midurethral tape (6%) and Burch colposuspension (6%) followed by transobturator tape (9%), and miscellaneous operations (12%), whereas the highest observed risk was for urethral injection therapy (44%). In a Cox proportional hazard model that adjusted for age, department volume, and calendar effect, the transobturator tape carried a 2-fold higher risk of reoperation (HR, 2.1; 95% CI, 1.5-2.9), and urethral injection therapy carried a 12 fold-higher risk (HR, 11.5; 95% CI, 9.3-14.3) compared with retropubic midurethral tape.
This nationwide cohort study provides physicians with a representative evaluation of the rate of reoperations after surgical procedures for urinary incontinence. Pubovaginal slings, Burch colposuspension, and retropubic midurethral tape had a similar risk of reoperation (6%). Women who were operated with transobturator tape had a significantly higher risk of reoperation compared with retropubic midurethral tape.
合成的中段尿道吊带于 20 世纪 90 年代问世，并迅速取代了耻骨后悬吊术成为尿失禁的金标准治疗方法。据报道，耻骨后中段尿道吊带在 5 年随访时具有 85%的客观和主观治愈率，但长期随访中耻骨后中段尿道吊带的再次手术率描述得并不充分。现有文献指出，初次治疗尿失禁后的终生再手术率约为 8-9%。然而，对于尿失禁的具体手术方法，再次手术的风险存在相互矛盾的说法。
本研究的目的是基于全国性人群，描述不同类型尿失禁手术 5 年内再次手术的累积发生率。
我们使用丹麦全国患者注册中心，确定了 1998 年至 2007 年间因尿失禁接受手术的女性，并将 5 年内再次手术作为结局。Kaplan-Meier 曲线用于估计 6 种尿失禁手术（耻骨后中段尿道吊带、经闭孔吊带、尿道注射治疗、耻骨后悬吊术、耻骨阴道吊带和其他手术）的再次手术率。Cox 比例风险模型用于估计危险比（HR）及其 95%置信区间（CI），并调整了可能与再次手术相关的因素。
共有 8671 名女性（平均年龄 56.1 岁，范围 6.7-93.7 岁）接受了尿失禁手术治疗。这些女性中，5820 名（67%）基线时接受了合成中段尿道吊带。任何治疗尿失禁的手术的再次手术累积发生率为 10%。接受耻骨阴道吊带（6%）、耻骨后中段尿道吊带（6%）和耻骨后悬吊术（6%）的女性再手术率最低，其次是经闭孔吊带（9%）和其他手术（12%），而尿道注射治疗的风险最高（44%）。在调整年龄、科室量和日历效应的 Cox 比例风险模型中，经闭孔吊带的再手术风险增加 2 倍（HR，2.1；95%CI，1.5-2.9），尿道注射治疗的再手术风险增加 12 倍（HR，11.5；95%CI，9.3-14.3），与耻骨后中段尿道吊带相比。
这项全国性队列研究为医生提供了对尿失禁手术治疗后再次手术率的代表性评估。耻骨阴道吊带、耻骨后悬吊术和耻骨后中段尿道吊带的再手术风险相似（6%）。接受经闭孔吊带的女性与接受耻骨后中段尿道吊带的女性相比，再手术风险显著增加。
