Steele Stephen S, Bailly Gregory G
Queen's University, Kingston, ON; Canada.
Department of Urology, Dalhousie University, Halifax, NS; Canada.
Can Urol Assoc J. 2017 Jun;11(6Suppl2):S132-S134. doi: 10.5489/cuaj.4635.
Recent data has demonstrated a one in five lifetime risk of a woman requiring stress urinary incontinence (SUI) surgery. Currently, most women opt for a synthetic midurethral sling (MUS), with over 3.6 million placed worldwide. This article attempts to identify whether a gold standard exists with regards to surgical correction of female SUI. When considering which sling type to use for which incontinent woman, the published data demonstrates excellent results for both synthetic mesh (retropubic or transobturator routes) and fascial pubovaginal slings for most patients. Intrinsic sphincter deficiency does appear to be better treated with the use of a retropubic approach, although still with less than stellar results. With little to differentiate, the treatment of most female SUI may be solely based on which sling the surgeon feels most comfortable performing. Currently, most urologists and gynecologists favour synthetic MUS over fascial slings in surgical-naïve patients; however, recent U.S Food and Drug Administration (FDA) warnings concerning the use of mesh in transvaginal surgery have patients questioning the safety of synthetic MUS for the treatment of SUI.
近期数据显示，女性一生中患压力性尿失禁（SUI）并需要接受手术治疗的风险为五分之一。目前，大多数女性选择使用合成材料的中段尿道吊带（MUS），全球范围内已植入超过360万个。本文旨在确定女性SUI手术矫正是否存在金标准。在考虑为失禁女性选择何种吊带类型时，已发表的数据表明，对于大多数患者而言，合成网片（耻骨后或经闭孔途径）和筋膜耻骨阴道吊带均能取得良好效果。尽管使用耻骨后途径治疗内在括约肌缺陷的效果仍不尽人意，但似乎确实更好。由于几乎没有明显差异，大多数女性SUI的治疗可能仅取决于外科医生最擅长操作哪种吊带。目前，在初次接受手术的患者中，大多数泌尿科医生和妇科医生更倾向于使用合成MUS而非筋膜吊带；然而，美国食品药品监督管理局（FDA）最近对经阴道手术中使用网片发出的警告，让患者对合成MUS治疗SUI的安全性产生了质疑。
