Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
Neurourol Urodyn. 2022 Nov;41(8):1834-1843. doi: 10.1002/nau.25032. Epub 2022 Sep 4.
Surgical treatment for stress urinary incontinence (SUI) with mid-urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF-US). The aim of this study was to investigate the role of PF-US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow-up.
A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society-Uniform Cough Stress Test, Incontinence Questionnaire-Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery.
Eighty-seven patients (80 transobturator-MUS, 7 retropubic-MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH O at 5 years of follow-up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline.
Patients cured of SUI had sonographically correct MUS by PF-US. Less than one-third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF-US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.
采用尿道中段悬吊带（MUS）治疗压力性尿失禁（SUI）的手术被认为成功率很高。然而，5%至 20%的 MUS 会失效，其中植入不当可能是 SUI 持续或复发的原因之一。盆腔超声（PF-US）可确定 MUS 的位置不当。本研究旨在探讨 MUS 治疗 SUI 术后中短期随访时出现持续性或复发性尿失禁（UI）症状患者的 PF-US 作用。
设计了一项回顾性队列研究，纳入 2013 年至 2015 年期间接受 MUS 手术治疗 SUI 的女性。主要结局是在术后 5 年时，将 MUS 的超声参数与 SUI 治愈（国际尿控协会-统一咳嗽压力测试阴性、尿失禁问卷-短表<5 分且无 SUI 症状）进行相关性分析。次要结局是术后 1 年和 5 年时最大尿道闭合压（MUCP）和急迫性尿失禁（UUI）症状的变化。
共纳入 87 例患者（80 例经闭孔-MUS，7 例经耻骨后-MUS）。5 年后，所有患者均报告 UI 改善，81.2%的患者客观治愈 SUI。68 例 SUI 治愈患者中，67 例（98.5%）的 MUS 超声结果正确。仅在 14 例非 SUI 治愈患者中，4 例（28.6%）的 MUS 被认为位置不当。5 年随访时 MUCP 从 61.9 降至 48.8cmH2O（p<0.01），术后多达 53%的女性出现 UUI 症状，但与基线相比无显著下降。
PF-US 显示 SUI 治愈患者的 MUS 超声结果正确。MUS 手术后 SUI 持续或复发的不到三分之一病例可归因于超声结果不正确的吊带。较低的尿道阻力和/或 UUI 症状可能有助于解释其余的失败。对于 MUS 治疗 SUI 术后持续性或复发性 SUI 患者，应在决定下一步管理策略之前，进行完整的功能和解剖学研究，包括尿动力学和 PF-US。
