Urology Department, Centro Hospitalar Universitário São João, Porto, Portugal,
Faculdade de Medicina da Universidade do Porto, Porto, Portugal,
Urol Int. 2021;105(1-2):143-147. doi: 10.1159/000511648. Epub 2020 Dec 2.
It is known that failures after midurethral slings increase with the follow-up time. Nevertheless, data concerning mini-slings are sparse. To clarify this statement, we analyze a mini-sling cohort with a median follow-up of 10 years. Although the brand used, MiniArc®, is no longer available, an identical device, Solyx™, can still be used, which makes the analysis of the cohort clinically relevant.
A total of 172 women with predominant stress urinary incontinence (SUI) were consecutively treated with the mini-sling MiniArc® from 2006 until 2013. They were reevaluated in 2018. The primary outcome, treatment success, was defined as no self-reported SUI symptoms and no reintervention. Secondary outcomes included the response to patient-reported outcomes. Adverse events were assessed.
After a median follow-up time of 113 months, 115 (66.9%) women were available for reevaluation. Forty-four (38.3%) women self-reported SUI. Seventeen women had been reoperated, 14 (12.2%) due to the reappearance of SUI and 3 due to complications. Altogether, MiniArc® had an overall success rate of 47.0% at 10 years. Among those not reoperated, 63.3% stated that they were much better or very much better in Patient Global Impression of Improvement (PGI-I) and 71.4% affirmed that their continence problem was normal or mild in Patient Global Impression of Severity (PGI-S). Almost 85% would repeat the surgery. Reoperation due to complications was rare (2.6%). De novo urgency appeared in 30.6% of the patients and it was managed with anticholinergic drugs with favorable outcomes.
DISCUSSION/CONCLUSION: This report adds evidence to the long-term outcomes of mini-slings, confirming that they can cure or improve SUI and give patients high satisfaction rates, at the expense of low morbidity.
已知尿道中段吊带术后失败的发生率会随着随访时间的延长而增加。然而，关于迷你吊带的数据却很少。为了澄清这一说法，我们分析了一个迷你吊带队列，中位随访时间为 10 年。尽管使用的品牌 MiniArc®已不再供应，但仍可使用相同的设备 Solyx™，这使得该队列的分析具有临床相关性。
2006 年至 2013 年期间，共有 172 名以压力性尿失禁（SUI）为主的女性连续接受了 MiniArc®迷你吊带治疗。2018 年对她们进行了重新评估。主要结局治疗成功定义为无自我报告的 SUI 症状和无再次干预。次要结局包括对患者报告结局的反应。评估了不良事件。
中位随访时间为 113 个月时，115 名（66.9%）女性可进行重新评估。44 名（38.3%）女性自我报告存在 SUI。17 名女性接受了再次手术，14 名（12.2%）因 SUI 再次出现，3 名因并发症。总体而言，10 年后 MiniArc®的总体成功率为 47.0%。在未接受再次手术的患者中，63.3%在患者总体印象改善量表（PGI-I）中表示“好得多”或“非常好”，71.4%在患者总体印象严重程度量表（PGI-S）中表示“正常”或“轻度”。近 85%的患者会再次接受手术。因并发症而再次手术的情况很少见（2.6%）。新出现的急迫性尿失禁发生率为 30.6%，通过使用抗胆碱能药物进行治疗，结果良好。
讨论/结论：本报告为迷你吊带的长期结果提供了证据，证实它们可以治愈或改善 SUI，并使患者满意度高，同时发病率低。
