Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India.
Neurourol Urodyn. 2021 Feb;40(2):659-665. doi: 10.1002/nau.24599. Epub 2020 Dec 21.
To assess the efficacy and safety of autologous mid-urethral sling (MUS) in women with predominant stress urinary incontinence (SUI).
This prospective cohort study included adult women with predominant SUI seen in our urology clinic between January 2018 and March 2019. Patients with: negative cough stress test, history of prior incontinence surgery, urogenital malignancy, pelvic radiation, neurological disease, body mass index more than 40 kg/m , the presence of more than Stage I pelvic organ prolapse, active urinary tract infection, maximum flow rate less than 15 ml/sec, postvoid residual urine more than 100 ml, abdominal leak point pressure less than 60 cm of H O, and pregnant women were excluded. Eligible patients underwent a transobturator MUS procedure using rectus fascia as a sling. Before the procedure, patients filled the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS) and the Female Sexual Function Index (FSFI) questionnaire. Urinary outcomes were assessed at 3- and 12-months while sexual outcomes were assessed at 12-months.
Thirty patients with median age of 44.5 years were included. All patients had a negative cough stress test during follow up. A significant improvement was noted in the ICIQ-FLUTS scale, bother scale, filling and incontinence subscales at 3 and 12 month follow-up. A significant improvement was also noted in the FSFI full scale score and FSFI domains of mean sexual desire, arousal and lubrication at 12 months follow-up. Two patients developed voiding dysfunction requiring urethral dilatation.
Autologous transobturator MUS surgery appears to be safe and efficacious in the short term. More research is needed to clarify its role in the surgical management of SUI in women.
评估自体中段尿道吊带（MUS）在以压力性尿失禁（SUI）为主的女性中的疗效和安全性。
本前瞻性队列研究纳入了 2018 年 1 月至 2019 年 3 月在我院泌尿科就诊的以压力性尿失禁为主的成年女性患者。排除标准为：咳嗽压力试验阴性、既往失禁手术史、泌尿生殖系统恶性肿瘤、盆腔放疗、神经疾病、体质量指数大于 40kg/m²、存在超过 I 度的盆腔器官脱垂、活动性尿路感染、最大尿流率小于 15ml/sec、残余尿量大于 100ml、腹压漏点压小于 60cmH₂O 和孕妇。符合条件的患者接受经闭孔 MUS 手术，使用腹直肌筋膜作为吊带。术前，患者填写国际尿失禁咨询委员会问卷-女性下尿路症状（ICIQ-FLUTS）和女性性功能指数（FSFI）问卷。术后 3 个月和 12 个月评估尿失禁结局，12 个月时评估性功能结局。
共纳入 30 例中位年龄为 44.5 岁的患者。所有患者在随访期间咳嗽压力试验均为阴性。术后 3 个月和 12 个月时，ICIQ-FLUTS 量表、困扰量表、充盈和失禁子量表均有显著改善。术后 12 个月时，FSFI 总分和平均性欲、唤醒和润滑域的 FSFI 领域也有显著改善。2 例患者出现排尿功能障碍，需要行尿道扩张。
自体经闭孔 MUS 手术在短期内似乎是安全有效的。需要进一步研究来明确其在女性 SUI 手术治疗中的作用。
