Svenningsen Rune, Oversand Sissel Hegdahl, Schiøtz Hjalmar August, Kulseng-Hanssen Sigurd
Department of Gynecology, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2021 Dec;100(12):2186-2192. doi: 10.1111/aogs.14271. Epub 2021 Oct 8.
Over the last two decades synthetic mid-urethral slings (MUS) have become established as the main surgical method for correcting stress urinary incontinence (SUI). However, transurethral injections with polyacrylamide hydrogel are gaining popularity. We used surgical codes from a national registry to explore potential differences in risk of later surgery for SUI comparing retropubic slings, obturator slings, and polyacrylamide hydrogel injections.
This cohort study used surgical codes from The Norwegian Patient Registry. All women recorded as having had surgery for SUI coded as retropubic sling, obturator sling, or polyacrylamide hydrogel injection from 2008 until end-of-study censoring in 2017, were included. Main outcome was time to any recorded new SUI procedure later in the study period. Unadjusted comparison between groups was done using Kaplan-Meier. A Cox regression analysis was then performed to adjust for hospital unit size and patient age at surgery.
The unadjusted analyses showed significant differences between the chosen index method and the risk of later SUI surgery favoring retropubic slings (p < 0.01). The proportions of patients without any recorded new SUI procedure at 1 and 5 years were 99.3% and 97.7% for retropubic MUS, 98.7% and 96.1% for obturator MUS, and 82.7% and 72.4% for polyacrylamide hydrogel injections. The majority of women having a repeat procedure for SUI after a polyacrylamide hydrogel injection underwent repeat treatment within 1 year (63%). After adjusting for age at time of surgery and hospital size, obturator slings (hazard ratio 1.8, 95% CI 1.4-2.4) and polyacrylamide hydrogel (hazard ratio 23.1, 95% CI 17.6-30.3) remained associated with a higher risk of later incontinence surgery.
Both retropubic and obturator slings have low long-term risks of repeat incontinence surgery compared with polyacrylamide hydrogel injections. Retropubic slings were found to have superior longevity of the surgical result.
在过去二十年中，合成尿道中段吊带术（MUS）已成为治疗压力性尿失禁（SUI）的主要手术方法。然而，聚丙烯酰胺水凝胶经尿道注射正越来越受欢迎。我们使用了国家登记处的手术编码，以探讨耻骨后吊带术、闭孔吊带术和聚丙烯酰胺水凝胶注射术在SUI后续手术风险方面的潜在差异。
这项队列研究使用了挪威患者登记处的手术编码。纳入了2008年至2017年研究结束时所有记录为接受过SUI手术的女性，手术编码为耻骨后吊带术、闭孔吊带术或聚丙烯酰胺水凝胶注射术。主要结局是在研究期间后续记录的任何新的SUI手术的时间。使用Kaplan-Meier进行组间未调整比较。然后进行Cox回归分析，以调整医院单位规模和手术时的患者年龄。
未调整分析显示，所选的索引方法与后续SUI手术风险之间存在显著差异，耻骨后吊带术更具优势（p < 0.01）。耻骨后MUS在1年和5年时无任何记录的新SUI手术的患者比例分别为99.3%和97.7%，闭孔MUS为98.7%和96.1%，聚丙烯酰胺水凝胶注射为82.7%和72.4%。大多数在聚丙烯酰胺水凝胶注射后因SUI进行重复手术的女性在1年内接受了重复治疗（63%）。在调整手术时的年龄和医院规模后，闭孔吊带术（风险比1.8，95%可信区间1.4 - 2.4）和聚丙烯酰胺水凝胶（风险比23.1，95%可信区间17.6 - 30.3）仍然与更高的后续尿失禁手术风险相关。
与聚丙烯酰胺水凝胶注射相比，耻骨后吊带术和闭孔吊带术的长期重复尿失禁手术风险较低。发现耻骨后吊带术的手术效果持久性更佳。
