Zilberlicht Ariel, Karmakar Debjyoti, Dwyer Peter L, Chan Garson, Schierlitz Lore
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.
Int J Gynaecol Obstet. 2023 Feb;160(2):579-587. doi: 10.1002/ijgo.14418. Epub 2022 Sep 7.
To investigate doctors' opinions of the use of synthetic mesh for the treatment of stress urinary incontinence (SUI) and the effect on patient's attitude following recent adverse publicity and legal findings.
Electronic survey approved by International Urogynecological Association (IUGA) and American Urogynecologic Society (AUGS), distributed to their members.
A total of 593 respondents completed the survey. The preferred initial surgical treatment for SUI was retropubic midurethral sling (MUS) (62%), followed by trans-obturator MUS (19%), mini-slings (10%), and then bulking agents (5%). Despite prolongation of consultation, most respondents (87%) believed that clinicians should provide a patient information leaflet (PIL) for their patients. However, only 70% of respondents were doing this. Most participants would use either the IUGA PIL or their institution PIL (61%). Only 8% felt that patients have a positive preconception of synthetic mesh for SUI. Eighty-three per cent of respondents had not changed their recommendations for treatment and the consent process. A logistic regression model identified preferences of certain geographic areas as predictors of consenting practices.
Despite the negative publicity and the current medicolegal litigation involving MUS for SUI treatment, the majority of respondents still prefer this as the initial surgical treatment. Most clinicians value PIL in the surgical consent process.
调查医生对于使用合成网片治疗压力性尿失禁（SUI）的看法，以及近期负面宣传和法律调查结果对患者态度的影响。
经国际尿控协会（IUGA）和美国妇科泌尿学会（AUGS）批准的电子调查问卷，分发给其成员。
共有593名受访者完成了调查。SUI首选的初始手术治疗方法是耻骨后中段尿道吊带术（MUS）（62%），其次是经闭孔MUS（19%）、微型吊带（10%），然后是填充剂（5%）。尽管咨询时间延长，但大多数受访者（87%）认为临床医生应为患者提供患者信息手册（PIL）。然而，只有70%的受访者这样做了。大多数参与者会使用IUGA的PIL或其所在机构的PIL（61%）。只有8%的人认为患者对用于SUI的合成网片有积极的先入之见。83%的受访者没有改变他们的治疗建议和同意程序。逻辑回归模型确定某些地理区域的偏好是同意做法的预测因素。
尽管有负面宣传以及目前涉及用于SUI治疗的MUS的医疗法律诉讼，但大多数受访者仍然更喜欢将其作为初始手术治疗方法。大多数临床医生重视手术同意过程中的PIL。
