Linder Brian J, Trabuco Emanuel C, Gebhart John B, Klingele Christopher J, Occhino John A, Elliott Daniel S, Lightner Deborah J
From the Department of Urology, and.
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN.
Female Pelvic Med Reconstr Surg. 2019 Jan/Feb;25(1):63-66. doi: 10.1097/SPV.0000000000000521.
The objective of the study was to evaluate the utility of urodynamic studies performed before primary midurethral sling placement for stress urinary incontinence in predicting the need for subsequent sling release for voiding dysfunction.
The health records of women managed with primary synthetic midurethral sling placement at Mayo Clinic (Rochester, MN) from January 1, 2002, to December 31, 2012, were reviewed. The primary outcome was surgical sling release for postoperative voiding dysfunction (ie, prolonged retention, elevated postvoid residual volumes with new voiding symptoms, or de novo onset or worsening of overactive bladder symptoms). Logistic regression models were used to evaluate associations between potential clinical risk factors and the primary outcome.
Overall, 1629 women underwent primary synthetic midurethral sling placement during the study time frame, including 1081 patients (66%) who underwent a preoperative multichannel urodynamic evaluation. A sling release for voiding dysfunction was performed for 51 patients (3.1%) at a median of 1.9 months postoperatively (interquartile range, 1.3-9.3 months). Patients undergoing sling release were significantly more likely to have had retropubic sling placement (P = 0.003) and concomitant prolapse surgery (P = 0.005). On univariate analysis, no urodynamic parameters were associated with the risk of sling release; evaluated parameters included peak flow rate (P = 0.20), postvoid residual volume (P = 0.37), voiding without detrusor contraction (P = 0.96), and detrusor pressure at maximal flow (P = 0.23).
Sling release for voiding dysfunction was rare in our cohort. No urodynamic parameters were associated with the risk of sling release.
本研究的目的是评估在初次中段尿道吊带置入治疗压力性尿失禁前进行尿动力学检查，对于预测后续因排尿功能障碍而需吊带松解的必要性的实用性。
回顾了2002年1月1日至2012年12月31日在梅奥诊所（明尼苏达州罗切斯特）接受初次合成中段尿道吊带置入治疗的女性的健康记录。主要结局是因术后排尿功能障碍（即尿潴留延长、排尿后残余尿量增加伴新的排尿症状，或膀胱过度活动症症状新发或加重）而进行手术吊带松解。采用逻辑回归模型评估潜在临床风险因素与主要结局之间的关联。
总体而言，在研究时间段内有1629名女性接受了初次合成中段尿道吊带置入治疗，其中1081例患者（66%）进行了术前多通道尿动力学评估。51例患者（3.1%）因排尿功能障碍在术后中位时间1.9个月（四分位间距，1.3 - 9.3个月）进行了吊带松解。接受吊带松解的患者耻骨后吊带置入（P = 0.003）和同期脱垂手术（P = 0.005）的可能性显著更高。单因素分析显示，没有尿动力学参数与吊带松解风险相关；评估的参数包括最大尿流率（P = 0.20）、排尿后残余尿量（P = 0.37）、无逼尿肌收缩排尿（P = 0.96）和最大尿流时的逼尿肌压力（P = 0.23）。
在我们的队列中，因排尿功能障碍而进行吊带松解的情况很少见。没有尿动力学参数与吊带松解风险相关。
