Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Central Hospital Østfold, Fredrikstad, Norway.
Arch Gynecol Obstet. 2022 Dec;306(6):2069-2075. doi: 10.1007/s00404-022-06737-4. Epub 2022 Aug 31.
Hysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse.
We included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9-14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence.
The re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03).
Hysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.
子宫切除术和中段尿道吊带术（MUS）是常见的手术，但对于 MUS 术后子宫切除术如何影响压力性尿失禁（SUI）复发的风险知之甚少。
我们纳入了 49 例 MUS 术后行子宫切除术的女性和 41 例 MUS 同期行子宫切除术的女性。对照组按照年龄（±2 岁）、MUS 类型（经耻骨后 vs 经闭孔）和手术年份（±2 年）进行匹配，共纳入 201 例未行后续子宫切除术而行 MUS 手术的女性。我们使用医疗保健登记系统对 MUS 手术后中位数为 12.4 年（IQR 10.9-14.7）的随访进行了研究，以比较 SUI 再次手术和因尿失禁再次就诊的人数。
MUS 术前行子宫切除术的女性（n=2，4.1%）、MUS 同期行子宫切除术的女性（n=2，4.9%）和她们的对照组（n=4，4.9%，p=0.8 和 n=6，5.0%，p=1.0）的 SUI 再次手术率无差异。与对照组（n=2 和 31，5 和 31%，p<0.01）和 MUS 术前行子宫切除术的女性（n=2 和 10，5 和 20%，分别，p=0.03）相比，MUS 同期行子宫切除术的女性因尿失禁再次就诊的次数明显更少。
MUS 术后或同期行子宫切除术似乎不会增加 SUI 再次手术或因尿失禁再次就诊的风险。这些结果可用于对考虑 MUS 术后或同期行子宫切除术的女性进行咨询。
