Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Neurourol Urodyn. 2020 Nov;39(8):2379-2385. doi: 10.1002/nau.24498. Epub 2020 Sep 9.
We investigated surgical outcomes and changes of overactive bladder (OAB) symptoms after midurethral sling in female stress urinary incontinence (SUI) patients with or without neurological disease (ND) without spinal cord injury.
Patients who underwent midurethral sling for SUI between January 2009 and December 2018 were reviewed. Postoperative changes in OAB symptoms (de novo occurrence or resolution) within 1 year were compared in each preoperative symptom subset with a 1:1 matched analysis between non-neurological disease (NND) and ND group.
A total of 855 patients (median follow-up: 49.8 months; mean age: 57.9 ± 9.3 years) were included. Successful SUI correction was achieved in 95.0% of NND and 93.7% of ND patients (p = .440). Among 797 patients (711 NND and 86 ND) without remnant SUI, 227 had SUI only, 198 had SUI with urgency, and 372 had mixed urinary incontinence (MUI) preoperatively. The ND patients tended to be older (62.8 ± 9.2 vs. 57.2 ± 9.0 years) and had higher proportions of diabetes (24.4% vs. 8.0%), hypertension (47.7% vs. 26.7%), and MUI (64.0% vs. 44.6%) than NND patients (p < .001, respectively). After matching age, diabetes, and hypertension, the incidence of de novo OAB was higher in ND patients (SUI only; 21.1% vs. 5.3%; p < .001) while resolution rates of urgency urinary incontinence (UUI) were similar (MUI; 57.7% vs. 53.9%; p = .414).
Success rates of midurethral sling and resolution of UUI were comparable between NND and ND patients. In patients with neurological conditions, de novo OAB symptoms were more likely to develop.
我们研究了女性压力性尿失禁（SUI）患者中有无神经系统疾病（ND）但无脊髓损伤的情况下，行尿道中段吊带术（MUS）后膀胱过度活动症（OAB）症状的手术结果和变化。
回顾了 2009 年 1 月至 2018 年 12 月期间接受 MUS 治疗 SUI 的患者。在每组术前症状亚组中，通过 1：1 匹配分析非神经疾病（NND）和 ND 组，比较术后 1 年内 OAB 症状（新发或缓解）的变化。
共纳入 855 例患者（中位随访时间：49.8 个月；平均年龄：57.9±9.3 岁）。NND 和 ND 患者的 SUI 治愈率分别为 95.0%和 93.7%（p=0.440）。在 797 例（711 例 NND 和 86 例 ND）无残余 SUI 的患者中，术前 227 例仅患有 SUI，198 例患有 SUI 伴急迫性尿失禁，372 例患有混合性尿失禁（MUI）。与 NND 患者相比，ND 患者年龄更大（62.8±9.2 岁 vs. 57.2±9.0 岁），糖尿病（24.4% vs. 8.0%）、高血压（47.7% vs. 26.7%）和 MUI（64.0% vs. 44.6%）的比例更高（p<0.001）。在匹配年龄、糖尿病和高血压后，新发 OAB 的发生率在 ND 患者中更高（仅 SUI：21.1% vs. 5.3%；p<0.001），而急迫性尿失禁（UUI）缓解率相似（MUI：57.7% vs. 53.9%；p=0.414）。
尿道中段吊带术的成功率和 UUI 的缓解率在 NND 和 ND 患者之间相似。在有神经疾病的患者中，更可能出现新的 OAB 症状。
