Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Neurourol Urodyn. 2020 Mar;39(3):994-1001. doi: 10.1002/nau.24321. Epub 2020 Feb 18.
To evaluate outcomes following urethral Macroplastique (MPQ) injection in women with stress urinary incontinence (SUI) following suburethral sling removal (SSR) for synthetic sling complications.
Following Institutional Review Board approval, charts of non-neurogenic women with SUI after SSR who underwent MPQ injection(s) and had at least 6 months minimum follow-up were reviewed from a prospectively maintained database. Demographic data, questionnaire (Urogenital Distress Inventory-6 [UDI-6] and Quality of Life) scores, and pad usage were recorded. Patients were followed with repeat questionnaires and three-dimensional ultrasound evaluating MPQ volume. Success following MPQ was defined as a composite score of a UDI-6 question 3 score of 0 to 1 at last visit and no additional anti-incontinence therapy.
From 2011 to 2018, 70 women with mean age 62.7 years met study criteria. At a mean follow-up of 46.4 ± 1.5 months, the success rate after the first MPQ injection was 46%. Following a repeat MPQ injection when indicated, the overall success rate for the entire cohort was 69%. Despite the objective failure, the majority of patients reported subjective improvement (83%) and reduced pad usage (78%). On multivariate analysis: age, body mass index, previous hysterectomy, hormone replacement therapy, type of sling removed and baseline urodynamics (UDS) parameters were not predictors of MPQ failure. Higher parity was a predictor of MPQ failure (hazard ratio = 1.980; P = .032).
MPQ injection is a durable and effective management option for SUI following SSR, although a second injection may be required to achieve the desired success.
评估尿道 Macroplastique（MPQ）注射在因合成吊带并发症而接受尿道下吊带切除（SSR）后出现压力性尿失禁（SUI）的女性中的治疗效果。
在获得机构审查委员会批准后，从一个前瞻性维护的数据库中回顾了非神经源性女性 SUI 患者的图表，这些患者在 SSR 后接受了 MPQ 注射治疗，并至少随访了 6 个月。记录了人口统计学数据、问卷（尿失禁生活质量问卷-6[UDI-6]和生活质量）评分和垫使用情况。通过重复问卷和三维超声评估 MPQ 体积来对患者进行随访。MPQ 成功定义为最后一次就诊时 UDI-6 问题 3 评分 0 至 1 的综合评分，且无其他抗失禁治疗。
2011 年至 2018 年，70 名平均年龄为 62.7 岁的女性符合研究标准。在平均 46.4±1.5 个月的随访中，首次 MPQ 注射的成功率为 46%。当需要时，再次进行 MPQ 注射，整个队列的总体成功率为 69%。尽管客观上失败了，但大多数患者报告主观改善（83%）和减少垫使用（78%）。多变量分析显示：年龄、体重指数、既往子宫切除术、激素替代疗法、切除的吊带类型和基线尿动力学（UDS）参数均不是 MPQ 失败的预测因素。较高的产次是 MPQ 失败的预测因素（风险比=1.980；P=0.032）。
MPQ 注射是 SSR 后 SUI 的一种持久且有效的治疗选择，尽管可能需要第二次注射才能达到预期的成功。
