El-Hamamsy Dina, Tincello Douglas G
University Hospitals of Leicester NHS Trust, Leicester, England.
Department of Health Sciences, College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
Int Urogynecol J. 2021 Jan;32(1):167-172. doi: 10.1007/s00192-020-04420-3. Epub 2020 Jul 23.
There is a lack of robust evidence guiding treatment options for recurrent stress urinary incontinence (SUI) and limited comparative outcome data. The aim of this study was to examine the pattern of surgery for recurrent SUI performed by gynaecologists in the UK and compare subjective success rates.
Retrospective review of the British Society of Urogynaecologists database for patients having repeat incontinence procedures (2007-2015) including the number of each procedure and outcome recorded by the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI-SF) questionnaire. Procedures were compared by year and outcomes by operation. Categorical comparisons were performed using Chi-squared test and numerical comparisons using appropriate non-parametric tests.
A total of 2,938 records were obtained (269 were excluded) and 2,164 women (88.8%) had undergone one previous procedure, most commonly retropubic midurethral sling (MUS; 28.6%). Pelvic floor exercises were offered to 76.2% women. Urodynamic investigation was carried out in 96.2% women: 76.5% had urodynamic stress incontinence. Repeat MUS was the most common procedure (77.3%), followed by bladder neck injections (BNI; 10.2%). Follow-up details were available for 66.1%. Outcome data were poorly reported. Median ICIQ-UI-SF score fell from 16 (0-21) to 0 (0-21) (p < 0.001), 81.6% felt "much better" or "very much better" on Patient Global Impression of Improvement (PGI-I), and 89.3% "cured" or "improved". MUS, colposuspension and fascial sling showed the best results with regard to the PGI-I score and "change in SUI" (p < 0.001).
MUS and BNI were the most common repeat continence procedures. Follow-up data suggest that MUS, colposuspension and fascial sling are most effective.
目前缺乏有力证据来指导复发性压力性尿失禁（SUI）的治疗方案，且比较性结局数据有限。本研究旨在调查英国妇科医生对复发性SUI进行手术的模式，并比较主观成功率。
对英国妇科泌尿外科学会数据库进行回顾性研究，纳入接受重复尿失禁手术的患者（2007 - 2015年），包括每种手术的数量以及通过国际尿失禁咨询委员会尿失禁简表（ICIQ - UI - SF）问卷记录的结局。按年份比较手术方式，按手术比较结局。分类比较采用卡方检验，数值比较采用适当的非参数检验。
共获得2938条记录（排除269条），2164名女性（88.8%）曾接受过一次手术，最常见的是耻骨后中段尿道吊带术（MUS；28.6%）。76.2%的女性接受了盆底肌锻炼。96.2%的女性进行了尿动力学检查：76.5%存在尿动力学压力性尿失禁。重复MUS是最常见的手术（77.3%），其次是膀胱颈注射（BNI；10.2%）。66.1%的患者有随访详情。结局数据报告不佳。ICIQ - UI - SF评分中位数从16（0 - 21）降至0（0 - 21）（p < 0.001），81.6%的患者在患者总体改善印象（PGI - I）中感觉“好多了”或“非常好多了”，89.3%的患者“治愈”或“改善”。就PGI - I评分和“SUI变化”而言，MUS、阴道旁修补术和筋膜吊带术显示出最佳结果（p < 0.001）。
MUS和BNI是最常见的重复尿失禁手术。随访数据表明，MUS、阴道旁修补术和筋膜吊带术最有效。
