Shamout Samer, Campeau Lysanne
Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
Can Urol Assoc J. 2017 Jun;11(6Suppl2):S155-S158. doi: 10.5489/cuaj.4613.
Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options.
压力性尿失禁(SUI)的手术治疗最常见的是通过植入尿道中段合成吊带(MUS)作为一线手术选择来实现。大量研究不断发展新的管理策略,以达到高效能与最小不良事件之间的最佳平衡。本专家意见综述简要而全面地讨论了SUI管理方面的最新进展和正在进行的研究,重点是单切口微型吊带、阴道激光治疗和基于细胞的治疗。它基于从众多已发表的荟萃分析和通过文献检索确定的原始研究中获得的数据。单切口微型吊带在治疗女性SUI方面,最初与标准MUS(耻骨后或经闭孔)相比似乎同样有效;然而,这种疗效缺乏超过一年随访的耐久性证据。除了显示出明显的初始安全性外,目前缺乏足够的临床证据来证实细胞治疗和非消融性阴道激光治疗的长期安全性和有效性。在这两种治疗方式广泛应用于临床实践之前,仍有重大挑战需要克服。未来的研究应旨在确定可能从这些微创治疗选择中受益的患者群体。