Department of Urology.
Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA.
Curr Opin Obstet Gynecol. 2020 Dec;32(6):449-455. doi: 10.1097/GCO.0000000000000658.
After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated.
Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling.
MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
2011 年美国食品和药物管理局发布关于经阴道网片的公共卫生通知后，中尿道吊带（MUS）的使用有所下降。然而，它们是治疗压力性尿失禁（SUI）的有效方法，并发症极少。吊带后复发性 SUI 的管理仍存在争议。
对原发性 MUS 的长期随访证实了其疗效和安全性。对于 MUS 失败后的最佳下一步，仍然没有 1 级证据。首选的治疗策略包括再次放置 MUS，最近的证据表明，经闭孔吊带和耻骨后入路的治愈率没有差异。耻骨后吊带（PVS）和尿道填充剂也是可接受的治疗选择。一种新型填充剂聚丙烯酰胺水凝胶在吊带失败后的患者中显示出极佳的短期成功率。
MUS 是治疗 SUI 的有效方法。出现复发性尿失禁的患者是一个异质人群，必须评估逼尿肌过度活动、吊带位置不当、未识别的 ISD。有 ISD 的患者更有可能从 PVS 中受益。其他经证实复发性 SUI 的患者可能会从再次放置 MUS 中获益。
