From the Department Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC.
Department Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA.
Female Pelvic Med Reconstr Surg. 2022 Apr 1;28(4):194-200. doi: 10.1097/SPV.0000000000001092. Epub 2021 Sep 22.
Despite large trials designed to guide management on whether to perform a prophylactic continence procedure at the time of pelvic organ prolapse (POP) repair, it remains unclear if a staged or interval approach confers advantages in treatment of bothersome stress urinary incontinence (SUI) in women without bothersome SUI before their POP repair.
The objective of this study was to compare success of concomitant versus interval slings for the prevention/treatment of de novo bothersome SUI after POP repair.
This multicenter retrospective cohort with prospective follow-up enrolled women with minimal or no SUI symptoms who underwent minimally invasive apical surgery for stage 2 or higher POP between 2011 and 2018 and had a concomitant sling placed at the time of POP surgery or an interval sling placed. Prospectively, all patients were administered the Urogenital Distress Inventory Short-Form 6, the Patient Global Impression of Improvement, and questions on reoperation/retreatment and complications.
A total of 120 patients had concomitant slings, and 60 had interval slings. There were no differences in the proportion of patients who had intrinsic sphincter deficiency (22% vs 20%), although the concomitant sling group was more likely to have a positive cough stress test result (30% vs 8%, P = 0.006). The interval sling group was more likely to report "yes" to SUI symptoms on Urogenital Distress Inventory Short-Form 6 (3% vs 30%, P = 0.0006) and during their postoperative visit (0% vs 24%, P < 0.0001). There were no differences in surgical complications.
Among women with minimal or no SUI symptoms undergoing prolapse repair, concomitant slings resulted in lower rates of bothersome SUI compared with similar women undergoing interval sling placement.
尽管有大型试验旨在指导在盆腔器官脱垂 (POP) 修复时是否进行预防性控尿术的管理，但在没有 POP 修复前就有烦扰性压力性尿失禁 (SUI) 的女性中，分期或间隔方法在治疗烦扰性 SUI 方面是否具有优势仍不清楚。
本研究旨在比较同期与间隔吊带术在预防/治疗 POP 修复后新发烦扰性 SUI 方面的效果。
这项多中心回顾性队列研究前瞻性随访了 2011 年至 2018 年间接受微创顶泌手术治疗 2 期或更高期 POP 且在 POP 手术时同时放置吊带或间隔放置吊带的最小或无 SUI 症状的女性。前瞻性地，所有患者均接受尿生殖窘迫量表简表 6 项、患者整体改善印象和再次手术/再治疗以及并发症相关问题的评估。
共有 120 例患者行同期吊带术，60 例行间隔吊带术。虽然同期吊带组更可能有阳性咳嗽应激试验结果（30% vs 8%，P=0.006），但两组患者中固有括约肌缺陷的比例没有差异（22% vs 20%）。间隔吊带组在尿生殖窘迫量表简表 6 项中报告“有”SUI 症状的比例更高（3% vs 30%，P=0.0006），在术后就诊时的报告比例更高（0% vs 24%，P<0.0001）。两组手术并发症无差异。
在接受脱垂修复的最小或无 SUI 症状的女性中，同期吊带术与间隔吊带术相比，新发烦扰性 SUI 的发生率更低。
