Weltz Vibeke, Guldberg Rikke, Larsen Michael D, Magnussen Bjarne, Lose Gunnar
Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark.
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.
Int Urogynecol J. 2018 Apr;29(4):585-591. doi: 10.1007/s00192-018-3570-1. Epub 2018 Feb 12.
The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery.
Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period.
During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5 years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09).
We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.
目的是评估体重指数（BMI）对首次中段尿道吊带手术后主观改善情况及再次手术风险的影响。
数据取自丹麦国家泌尿妇科数据库，包括2011年至2016年接受首次中段尿道聚丙烯吊带手术的女性。主观改善情况通过基于术前及术后3个月填写的国际尿失禁咨询问卷简表（ICIQ-SF）的症状差异来评估。再次手术定义为在研究期间因压力性尿失禁进行的任何新的外科手术。
在研究期间，共进行了6414例中段尿道吊带手术；其中80.0%的女性填写了术前和术后的国际尿失禁咨询问卷（ICI-Q）表格。42.4%的女性BMI＜25，34.6%的女性BMI为25 - 30，16.9%的女性BMI为30 - 35，6.0%的女性BMI＞35。所有BMI类别术后主观改善情况均良好，各类别之间无差异。随访2年时的总体累积风险比例为1.9%（95%CI：1.6 - 2.3），5年时为2.4%（95%CI：2.0 - 2.9）。在对年龄、吸烟和饮酒情况进行调整后，BMI＞35的女性随访2年时的累积风险比例为3.2%（95%CI：1.6 - 6.2），5年时为4.0%（95%CI：2.0 - 7.7），这是研究中再次手术比例最高的情况。BMI＞35的女性的粗风险比为1.84（95%CI：0.89 - 3.83），调整后的风险比为1.94（95%CI：0.92 - 4.09）。
我们发现首次手术后主观改善情况良好，与BMI无关。BMI超过35的女性再次手术比例最高，尽管这在统计学上无显著意义。
