Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
J Urol. 2016 Aug;196(2):478-83. doi: 10.1016/j.juro.2016.01.091. Epub 2016 Jan 25.
We evaluate urgency urinary incontinence outcomes for patients who underwent revision of a presumed obstructing synthetic mid urethral sling and examine risk factors for persistent or de novo symptoms after surgery.
From February 1, 2005 to June 1, 2013, 107 women underwent sling revision for new or worsening lower urinary tract symptoms after synthetic mid urethral sling surgery. Patients were grouped based on urgency urinary incontinence symptoms and characteristics associated with persistent or de novo symptoms after revision were examined using logistic regression models.
Median followup was 29 months (IQR 12-54) and time to revision was 21 months (IQR 5-48). Patients presenting for sling revision with urgency incontinence (68) were more likely to experience a more than 6-month delay to revision vs those presenting with obstructive voiding symptoms (39) (OR 3.25, 95% CI 1.33-7.92, p <0.01). After revision urgency incontinence persisted in 76.5% (52 of 68) and was associated with a pre-revision need for anticholinergic medication (OR 5.58, 95% CI 1.44-21.39, p=0.01) and smoking (OR 5.21, 95% CI 1.21-22.49, p=0.03). De novo urgency incontinence developed in 43.6% (17 of 39) of patients and was associated with de novo stress incontinence (OR 15.9, 95% CI 3.2-78.3, p <0.01). Women with post-revision urgency incontinence (de novo or persistent) had higher Urogenital Distress Inventory-6 scores than patients with no or resolution of urgency incontinence.
Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de novo urgency incontinence after sling revision. Patient expectations should be managed accordingly before sling revision.
我们评估了因疑似阻塞性合成中尿道吊带而接受修复的患者的急迫性尿失禁结局，并研究了手术后持续性或新发症状的危险因素。
从 2005 年 2 月 1 日至 2013 年 6 月 1 日，107 名女性因合成中尿道吊带手术后出现新的或加重的下尿路症状而接受吊带修复。根据急迫性尿失禁症状将患者分组，并使用逻辑回归模型检查与修复后持续性或新发症状相关的危险因素。
中位随访时间为 29 个月（IQR 12-54），修复时间为 21 个月（IQR 5-48）。因急迫性尿失禁就诊的患者（68 例）比因阻塞性排尿症状就诊的患者（39 例）更有可能延迟至修复时间超过 6 个月（OR 3.25，95%CI 1.33-7.92，p <0.01）。修复后，76.5%（52/68）的急迫性尿失禁持续存在，且与修复前需要抗胆碱能药物治疗（OR 5.58，95%CI 1.44-21.39，p=0.01）和吸烟（OR 5.21，95%CI 1.21-22.49，p=0.03）相关。43.6%（17/39）的患者新发急迫性尿失禁，且与新发压力性尿失禁相关（OR 15.9，95%CI 3.2-78.3，p <0.01）。有修复后急迫性尿失禁（新发或持续存在）的患者的尿失禁影响问卷-6 评分高于无急迫性尿失禁或已缓解的患者。
与因阻塞性排尿症状就诊的患者相比，因吊带置入后出现新的或加重的急迫性尿失禁就诊的患者更有可能延迟修复。吊带修复后存在较高的持续性和新发急迫性尿失禁发生率。在进行吊带修复前，应相应地管理患者的预期。
