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聚丙烯和聚偏二氟乙烯经闭孔吊带治疗女性压力性尿失禁:一项多中心随机试验的 1 年结果。

Polypropylene and polyvinylidene fluoride transobturator slings for the treatment of female stress urinary incontinence: 1-Year outcomes from a multicentre randomized trial.

机构信息

Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.

General Surgery Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.

出版信息

Neurourol Urodyn. 2021 Jan;40(1):475-482. doi: 10.1002/nau.24586. Epub 2020 Dec 1.

DOI:10.1002/nau.24586
PMID:33259073
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7839450/
Abstract

AIMS

To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI).

METHODS

This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models.

RESULTS

From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events.

CONCLUSION

PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.

摘要

目的

比较聚丙烯(PP)和聚偏二氟乙烯(PVDF)经闭孔尿道悬吊带(TOT)治疗女性压力性尿失禁(SUI)的有效性和安全性。

方法

这是一项多中心随机试验。患有 SUI 或以压力为主的混合性尿失禁且计划行 TOT 手术的女性被随机分配至 PP 或 PVDF 吊带组。主要结局为采用综合标准评估的 1 年治愈率或改善率。还比较了并发症。使用多变量逻辑回归模型分析与结局的关系。

结果

2016 年 4 月至 2018 年 1 月,共有 285 名参与者被随机分组。PP 和 PVDF 吊带的治愈率或改善率相似(91.0% vs. 95.6%,p=0.138)。经验证的问卷评分改善情况也相似。PVDF 吊带与新发急迫性尿失禁的发生率较低相关(调整后的优势比=0.35;95%置信区间=0.15-0.80)。我们发现并发症发生率无统计学差异,尽管在 PP 组中观察到长期疼痛事件的发生率较高。由于事件数量较少,该研究在发现特定并发症方面的效力不足。

结论

PP 和 PVDF TOT 的疗效相当,尽管 PVDF 与新发急迫性尿失禁的病例较少有关。需要进一步的研究来得出关于安全性的可靠结论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8860/7839450/24d98724ec34/NAU-40-475-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8860/7839450/24d98724ec34/NAU-40-475-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8860/7839450/24d98724ec34/NAU-40-475-g001.jpg

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Laparoscopic Bilateral Cervicosacropexy and Vaginosacropexy: New Surgical Treatment Option in Women with Pelvic Organ Prolapse and Urinary Incontinence.腹腔镜双侧宫颈-骶骨固定术和阴道-骶骨固定术:盆腔器官脱垂伴尿失禁女性的新手术治疗选择。
J Endourol. 2018 Nov;32(11):1058-1064. doi: 10.1089/end.2018.0474.
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De novo overactive bladder following midurethral sling procedures: a systematic review of the literature and meta-analysis.经尿道中段吊带术术后新发膀胱过度活动症:文献系统评价与荟萃分析
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