Yang Pei Shan, Delpe Sophia, Kowalik Casey G, Reynolds W Stuart, Kaufman Melissa R, Dmochowski Roger R
Department of Urologic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Res Rep Urol. 2021 Aug 14;13:591-596. doi: 10.2147/RRU.S321955. eCollection 2021.
Pubovaginal sling is an efficient and safe procedure for stress urinary incontinence without the complications of synthetic sling. Urine retention and de novo urgency are bothersome aftermath of this procedure. We aim to identify potential risk factors for de novo urgency after autologous pubovaginal sling.
From 2013 to 2016, 347 patients underwent autologous pubovaginal sling. Age, BMI, pelvic irradiation, use of anticholinergic medication, previous vaginal related surgical histories, "over-tight" technique, and concomitant surgeries were examined for potential risk factors. De novo urgency/urge incontinence was defined as treatment (medication, botulinum toxin injection, sacral neuromodulation) for urge postoperatively and was not noted before surgery. Chi-square and fisher's exact tests were used as statistical analysis.
A total of 109 patients underwent autologous rectus fascia pubovaginal sling, after excluding status post urethral diverticulectomy, concomitant diverticulectomy, and concomitant abdominal surgery. Twenty-three (21.1%) patients were treated for de novo urge/urge incontinence, 18 (78.2%) with anticholinergic, 4 (17.3%) with botox injection and 2 (8.69%) with sacral neuromodulation. None but prior pelvic organ prolapse surgery was associated with developing de novo urge/urge incontinence (p=0.026).
Patients with prior pelvic organ prolapse surgery were more likely to be at risk of de novo urgency after autologous pubovaginal sling. This study provided more information for preoperative consultation for patients undergoing incontinence surgery.
耻骨后阴道吊带术是治疗压力性尿失禁的一种有效且安全的手术方法，不会出现合成吊带的并发症。尿潴留和新发尿急是该手术令人困扰的后遗症。我们旨在确定自体耻骨后阴道吊带术后新发尿急的潜在危险因素。
2013年至2016年，347例患者接受了自体耻骨后阴道吊带术。对年龄、体重指数、盆腔放疗、抗胆碱能药物的使用、既往阴道相关手术史、“过紧”技术及同期手术进行检查，以寻找潜在危险因素。新发尿急/急迫性尿失禁定义为术后因尿急接受治疗（药物、肉毒杆菌毒素注射、骶神经调节），且术前未出现。采用卡方检验和费舍尔精确检验进行统计分析。
排除尿道憩室切除术后、同期憩室切除术及同期腹部手术后，共有109例患者接受了自体腹直肌筋膜耻骨后阴道吊带术。23例（21.1%）患者因新发尿急/急迫性尿失禁接受治疗，其中18例（78.2%）使用抗胆碱能药物，4例（17.3%）接受肉毒杆菌毒素注射，2例（8.69%）接受骶神经调节。除既往盆腔器官脱垂手术外，无其他因素与新发尿急/急迫性尿失禁相关（p=0.026）。
既往接受盆腔器官脱垂手术的患者在自体耻骨后阴道吊带术后更易出现新发尿急。本研究为接受尿失禁手术的患者术前咨询提供了更多信息。
