Department of Geriatrics, Dalens Hospital, Stockholm, Sweden.
Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Int Urogynecol J. 2023 Apr;34(4):939-947. doi: 10.1007/s00192-022-05364-6. Epub 2022 Oct 1.
The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, ASA) classification on outcomes.
Cure rate, change in frequency of lower urinary tract symptoms, satisfaction, impact, and adverse events after MUS surgery were assessed in 5200 women aged 55-94 years with MUS surgery (2010-2017). Data were analysed by multivariate logistic regression and Mantel-Haenszel chi-square statistics.
The cure rate was 64.2% (95% CI, 60.0-68.4) in the ≥ 75-year cohort compared to 88.5% (95% CI, 87.1-89.8) in the 55-64-year cohort (trend p < 0.0001). The estimated probability of cure, improvement, and satisfaction with the procedure decreased by aOR = 0.51 for cure to aOR = 0.59 for satisfaction (all p < 0.0001). Women with a significant health burden (ASA class 3-4) had lower cure rates and satisfaction than those without (65.5% vs. 83.7%, p < 0.0001 and 65.7% vs. 80.6%, p < 0.0001). Older age was more likely to be associated with de novo urgency (p = 0.0022) and nocturia ≥ 2 (p < 0.0001). Adverse events, readmission, and 30-day mortality rates were low. Women, irrespective of age, were equally satisfied if they experienced a decrease of at least one step in leakage frequency.
Even if MUS surgery in older women and those with ASA class 3-4 was associated with a lower cure rate and less satisfactory outcome, a majority were satisfied provided they experienced a reduction of incontinence episodes.
中尿道吊带（MUS）手术在老年女性和患有重大疾病的女性中的疗效有限。我们旨在确定年龄和身体状况（通过美国麻醉医师协会身体状况分类评估，ASA）对结果的影响。
评估了 5200 名年龄在 55-94 岁之间接受 MUS 手术的女性（2010-2017 年）的治愈率、下尿路症状频率变化、满意度、影响和不良事件。数据通过多变量逻辑回归和 Mantel-Haenszel χ2 统计分析。
≥75 岁组的治愈率为 64.2%（95%CI，60.0-68.4），而 55-64 岁组的治愈率为 88.5%（95%CI，87.1-89.8）（趋势 p <0.0001）。治愈、改善和对手术的满意度的估计概率分别降低了 aOR=0.51（p <0.0001）和 aOR=0.59（p <0.0001）。有重大健康负担（ASA 3-4 级）的女性的治愈率和满意度低于无重大健康负担的女性（65.5%比 83.7%，p <0.0001 和 65.7%比 80.6%，p <0.0001）。年龄越大，更有可能出现新发急迫性（p=0.0022）和夜间排尿≥2 次（p<0.0001）。不良事件、再入院和 30 天死亡率较低。无论年龄大小，如果女性漏尿频率至少降低一个等级，她们的满意度都是相等的。
即使在老年女性和 ASA 3-4 级女性中进行 MUS 手术，其治愈率和满意度较低，但大多数女性如果经历了失禁发作次数的减少，仍会感到满意。
