Division of Urogynecology, the Division of Biomedical Statistics and Informatics, and the Department of Urology, Mayo Clinic, Rochester, Minnesota; the Clinical Pharmacology Division, Vanderbilt University, Vanderbilt, Tennessee; and the Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio.
Obstet Gynecol. 2019 Aug;134(2):333-342. doi: 10.1097/AOG.0000000000003356.
To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.
We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure.
We identified 1,881 women who underwent a sling procedure for primary SUI-1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein are based on the covariate-matched cohort. Women undergoing a transobturator sling procedure had an increased risk of reoperation for recurrent SUI compared with women undergoing a retropubic sling procedure (hazard ratio 2.42, 95% CI 1.37-4.29). The cumulative incidence of reoperation for recurrent SUI by 8 years was 5.2% (95% CI 3.0-7.4%) in the retropubic group and 11.2% (95% CI 6.4-15.8%) in the transobturator group. Women in the retropubic group had a significantly higher rate of intraoperative complications compared with women in the transobturator group (13.7% [78/570] vs 4.7% [15/317]; difference=9.0%, 95% CI for difference 5.3-12.6%); the majority of this difference was due to bladder perforation (7.0% [40/570] vs 0.6% [2/317]; difference=6.4%, 95% CI for difference 4.1-8.7%). The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups.
Women with primary SUI treated with a retropubic sling procedure have significantly lower cumulative incidence of reoperation for recurrent SUI compared with women who were treated with a transobturator sling procedure. Retropubic slings were associated with a higher risk of sling revision for urinary retention.
比较经耻骨后和经闭孔吊带术治疗复发性压力性尿失禁（SUI）的再次手术率。
我们对 2002 年至 2012 年间在一家机构接受经尿道吊带术治疗原发性 SUI 的所有女性进行了回顾性队列研究。为了最大程度地减少偏倚，两组女性在年龄、体重指数、单纯手术与联合手术、术前诊断方面进行了匹配。主要结局定义为复发性 SUI 的再次手术。次要结局包括术中并发症和吊带手术后需要再次手术的网片相关并发症。
我们确定了 1881 名女性接受吊带术治疗原发性 SUI，其中 1551 名接受经耻骨后手术，330 名接受经闭孔手术。在接受经耻骨后吊带术和经闭孔吊带术的 570 名和 317 名配对协变量匹配队列中，两组在任何评估的基线变量上均无差异；本文的结果基于协变量匹配队列。与接受经耻骨后吊带术的女性相比，接受经闭孔吊带术的女性再次手术治疗复发性 SUI 的风险增加（风险比 2.42，95%CI 1.37-4.29）。经耻骨后组 8 年时复发性 SUI 的再次手术累积发生率为 5.2%（95%CI 3.0-7.4%），经闭孔组为 11.2%（95%CI 6.4-15.8%）。与经闭孔组相比，经耻骨后组女性术中并发症发生率显著更高（13.7%[78/570] vs 4.7%[15/317]；差异=9.0%，95%CI 5.3-12.6%）；这种差异主要是由于膀胱穿孔（7.0%[40/570] vs 0.6%[2/317]；差异=6.4%，95%CI 4.1-8.7%）。两组术后 5 年时因尿潴留行吊带修复术的累积发生率均稳定在 3.2%和 0.4%。
与接受经闭孔吊带术治疗的女性相比，接受经耻骨后吊带术治疗的原发性 SUI 女性再次手术治疗复发性 SUI 的累积发生率显著降低。经耻骨后吊带术与吊带术后尿潴留的风险增加相关。
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