Mcloughlin Louise C, Gleeson Mari, Francis Sami, O'rourke Colin, Flood Hugh D
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Can Urol Assoc J. 2018 Nov;12(11):E461-E465. doi: 10.5489/cuaj.5161. Epub 2018 Jun 8.
Pubo-vaginal sling placed at the bladder neck is the gold standard treatment for stress urinary incontinence (SUI). The synthetic mid-urethral sling (MUS) is now widely used, as morbidity rates with this technique are substantially reduced. This is an initial report on long-term outcomes of a polypropylene sling (PPS) placed in the traditional bladder neck location.
A retrospective analysis of all patients who underwent PPS insertion at our institution between 2006 and 2014 was conducted. Patient and urodynamic demographics were recorded. Subjective and objective measures of success were determined by postoperative pad usage and validated incontinence questionnaires.
A total of 170 patients were followed for a median of four years (range 1-8). The mean age was 51 years (±10). Subjective response was assessed in 57% of patients; the overall subjective cure rate was 85.3% (n=145), subjective improvement rate was 4.1% (n=7), and the subjective failure rate was 10.6% (n=18). The mean Urogenital Distress Inventory (UDI)-6 score was 6.5 (±5.6) out of a maximum score of 24 and the Incontinence Impact Questionnaire (IIQ)-7 score was 5.5 (±6.3) out of a maximum score of 28. There was no significant difference in objective outcome measures in those with an abdominal leak-point pressure (ALPP) < or >60 cmHO.
Bladder neck placement of a PPS resulted in cure rates of 85% in this series. SUI secondary to intrinsic sphincter deficiency (ISD) and urethral hypermobility were treated with equal success. Bladder neck PPS placement has a role in the treatment of SUI. Our data may well reassure rectus fascia sling (RFS) surgeons who wish to take advantage of faster postoperative recovery using the less invasive PPS placed at the bladder neck.
耻骨阴道吊带放置于膀胱颈是压力性尿失禁（SUI）的金标准治疗方法。合成材料的中段尿道吊带（MUS）目前被广泛应用，因为该技术的发病率显著降低。这是一篇关于置于传统膀胱颈位置的聚丙烯吊带（PPS）长期疗效的初步报告。
对2006年至2014年期间在我院接受PPS植入的所有患者进行回顾性分析。记录患者和尿动力学人口统计学数据。通过术后护垫使用情况和经过验证的尿失禁问卷来确定主观和客观的成功指标。
共对170例患者进行了中位时间为4年（范围1 - 8年）的随访。平均年龄为51岁（±10岁）。57%的患者接受了主观反应评估；总体主观治愈率为85.3%（n = 145），主观改善率为4.1%（n = 7），主观失败率为10.6%（n = 18）。泌尿生殖系统困扰量表（UDI）-6的平均得分在满分24分中为6.5分（±5.6分），尿失禁影响问卷（IIQ）-7的平均得分在满分28分中为5.5分（±6.3分）。腹部漏尿点压力（ALPP）<或>60 cmH₂O的患者在客观结果指标上无显著差异。
在本系列研究中，PPS置于膀胱颈的治愈率为85%。继发于内在括约肌缺陷（ISD）和尿道活动过度的SUI得到了同样成功的治疗。膀胱颈PPS置入在SUI治疗中具有一定作用。我们的数据可能会让那些希望利用在膀胱颈放置侵入性较小的PPS以实现更快术后恢复的腹直肌筋膜吊带（RFS）外科医生放心。
