Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Kaiser Permanente, Downey, California; the Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; the Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina.
Obstet Gynecol. 2020 Sep;136(3):482-491. doi: 10.1097/AOG.0000000000003989.
To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence.
Four hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) against midurethral sling alone for mixed incontinence with 1 year of follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective failure, objective failure, or both. Subjective failure was defined as not meeting the minimal clinically important difference for improvement on the UDI (Urogenital Distress Inventory)-total score (26.1 points). Objective failure was not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated.
Previous overactive bladder medication use (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.89, 95% CI 1.10-3.25), detrusor overactivity on cystometrogram (OR 2.25, aOR 2.72, 95% CI 1.53-4.84), body mass index (OR 1.29, aOR 1.27, 95% CI 1.03-1.57), and Valsalva leak point pressure less than 60 cm H2O (OR 1.96, aOR 3.13, 95% CI 1.65-5.94) were associated with overall failure. Worse UDI urgency scores were associated with failure in the midurethral sling-alone group. Sling type (retropubic vs transobturator) was not associated with failure.
Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling among women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. This information is helpful for counseling women with mixed incontinence who are considering surgery.
ClinicalTrials.gov, NCT01959347.
评估女性混合性尿失禁患者行尿道中段吊带术后 1 年时与治疗失败相关的特征。
403 名参加了一项随机试验的女性符合本计划二次分析的入选标准，该试验比较了尿道中段吊带术联合行为和盆底肌肉治疗（联合组）与单纯尿道中段吊带术治疗混合性尿失禁，随访时间为 1 年。总体治疗失败定义为符合主观失败、客观失败或两者兼有的标准。主观失败定义为在 UDI（尿失禁生活质量问卷）总评分上未达到 26.1 分的最小临床重要差异的改善。客观失败是指在术后 12 个月时任何类型的平均失禁发作次数未达到 70%的改善，或因尿症状而接受任何其他治疗。建立了治疗失败的逻辑回归模型。自变量包括地点和治疗组以及基于双变量比较的临床和人口统计学变量（P<.2）。评估了治疗组间的相互作用效应。
既往逼尿过度药物治疗史（未调整的优势比 [OR] 2.19，调整后的优势比 [aOR] 1.89，95%置信区间 [CI] 1.10-3.25）、膀胱测压时逼尿肌过度活动（OR 2.25，aOR 2.72，95%CI 1.53-4.84）、体重指数（OR 1.29，aOR 1.27，95%CI 1.03-1.57）和 Valsalva 漏点压力<60cmH2O（OR 1.96，aOR 3.13，95%CI 1.65-5.94）与总体失败相关。尿道中段吊带组的 UDI 急迫评分更差与失败相关。吊带类型（耻骨后与经闭孔）与失败无关。
在女性混合性尿失禁患者中，某些临床和尿动力学变量与尿道中段吊带术后治疗失败相关。基线时急迫症状更严重的女性可能受益于围手术期行为和盆底肌肉治疗联合尿道中段吊带术。这些信息有助于为考虑手术的混合性尿失禁女性提供咨询。
ClinicalTrials.gov，NCT01959347。
