Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway.
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Acta Obstet Gynecol Scand. 2020 Aug;99(8):1071-1077. doi: 10.1111/aogs.13830. Epub 2020 Mar 13.
The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20 years. In this study, we assessed associations between surgeon's experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates.
Using a consecutive case-series design, we assessed 596 patients treated with primary retropubic tension-free vaginal tape surgery performed by 18 surgeons from 1998 through 2012, with follow up through 2015 (maximum follow-up time: 10 years per patient). Data on perioperative complications and recurrence of stress urinary incontinence from medical records was transferred to a case report form. Surgeon's experience with the tension-free vaginal tape procedure was defined as number of such procedures performed as lead surgeon (1-19 ["beginners"], 20-49 and ≥50 procedures). All analyses were done with a 5% level of statistical significance. We applied the Chi-square test in the assessment of perioperative complications. The regression analyses of recurrence rate by number of tension-free vaginal tape procedures performed were restricted to the three surgeons who performed ≥50 procedures.
We found a significantly higher rate of bladder perforations (P = .03) and a higher rate of urinary retentions among patients whose tension-free vaginal tape procedures were performed by "beginners" (P = .06). We observed a significant reduction in recurrence rates with increasing number of tension-free vaginal tape procedures for one surgeon (P = .03).
Surgeon's experience with the tension-free vaginal tape procedure is associated with the risk of bladder perforation and urinary retention, and may be associated with the long-term effectiveness of the procedure.
经耻骨后无张力阴道吊带术已被公认为治疗女性压力性和压力主导型混合性尿失禁的首选手术方法 20 余年。在此研究中，我们评估了术者施行初次经耻骨后无张力阴道吊带术的经验与围手术期并发症和复发率之间的相关性。
我们采用连续病例系列设计，评估了 1998 年至 2012 年间由 18 位外科医生施行的 596 例初次经耻骨后无张力阴道吊带术患者的临床资料，随访至 2015 年（每位患者的最长随访时间为 10 年）。从病历中获取与围手术期并发症和压力性尿失禁复发相关的数据，并将其转移到病例报告表中。术者施行经耻骨后无张力阴道吊带术的经验定义为作为术者施行该手术的例数（1-19 例[初学者]、20-49 例和≥50 例）。所有分析均采用 5%的统计显著性水平。我们采用卡方检验评估围手术期并发症。对施行无张力阴道吊带术例数与复发率的回归分析仅限于施行≥50 例手术的三位外科医生。
我们发现，初学者施行的无张力阴道吊带术患者的膀胱穿孔率（P=0.03）和尿潴留发生率更高（P=0.06）。我们发现，随着无张力阴道吊带术施行例数的增加，一位外科医生的复发率显著降低（P=0.03）。
术者施行经耻骨后无张力阴道吊带术的经验与膀胱穿孔和尿潴留的风险相关，并且可能与该手术的长期效果相关。
