Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland.
Maturitas. 2022 Sep;163:28-37. doi: 10.1016/j.maturitas.2022.05.007. Epub 2022 May 26.
Recurrent stress urinary incontinence (rSUI) represents a major challenge for most clinicians as there is little evidence in the literature on the best option after sling failure. The objective of this study is to summarise the findings on the use of urethral bulking agents (UBAs) in the management of rSUI after the failure of a mid-urethral sling (MUSs). We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected eleven publications for inclusion in the analysis. We found that the overall cure and improvement rate ranged from 64% to 85% in the included studies, with a pooled value of 75%, compared with pooled failure and re-operation rates of 32% (95% CI: 22%-43%) and 25% (95% CI: 17%-34%), respectively. The I test indicated significant statistical heterogeneity among the studies in relation to all the outcome measures; however, no risk of publication bias was found. To explore this heterogeneity in more depth, we performed a sub-group analysis of the two most commonly used bulking agents (Bulkamid and Macroplastique). The pooled values of the cure and improvement rate were 84% (95% CI: 77.0%-90.0%) and 80% (95% CI: 74.0%-85.0%) for Macroplastique and Bulkamid, respectively. We did not find significant heterogeneity or significant differences in the outcome measures in either group. For the first time in literature, our study provides an insight into the use of UBAs after failed MUSs. Although the results seem very promising, future studies with shared protocols are needed in order to recommend the use of UBAs in the treatment of recurrent cases.
复发性压力性尿失禁（rSUI）对大多数临床医生来说是一个主要挑战，因为在吊带失败后的最佳选择方面，文献中几乎没有证据。本研究的目的是总结尿道填充剂（UBAs）在治疗中隔吊带（MUSs）失败后 rSUI 的应用。我们根据 PRISMA 2020 指南进行了系统评价和荟萃分析，并选择了 11 篇文献进行分析。我们发现，纳入研究的总体治愈率和改善率为 64%至 85%，合并值为 75%，而合并失败率和再次手术率分别为 32%（95%CI：22%-43%）和 25%（95%CI：17%-34%）。I 检验表明，所有结局指标的研究之间存在显著的统计学异质性；然而，未发现发表偏倚的风险。为了更深入地探讨这种异质性，我们对两种最常用的填充剂（Bulkamid 和 Macroplastique）进行了亚组分析。Macroplastique 和 Bulkamid 的治愈率和改善率的合并值分别为 84%（95%CI：77.0%-90.0%）和 80%（95%CI：74.0%-85.0%）。我们在两组中均未发现结局指标存在显著异质性或显著差异。我们首次在文献中提供了使用 UBAs 治疗失败的 MUSs 的见解。尽管结果看起来很有希望，但仍需要进行具有共享方案的未来研究，以便推荐在复发性病例中使用 UBAs。
