From the Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange.
Department of Obstetrics and Gynecology.
Urogynecology (Phila). 2023 Feb 1;29(2):133-138. doi: 10.1097/SPV.0000000000001319.
There is limited current literature regarding the retreatment of stress urinary incontinence (SUI) after midurethral sling (MUS) placement with prior urethral bulking.
The objective was to evaluate the retreatment and perioperative complications of MUS placement with prior urethral bulking compared with MUS placement without prior urethral bulking.
This was a retrospective cohort study of patients within the Southern California Permanente Medical Group who underwent MUS placement from January 2009 to December 2020. Patients who underwent prior urethral bulking were compared with a control group without prior urethral bulking in a 1:1 ratio matched by age and MUS procedure date. The primary outcome was the retreatment of SUI after MUS placement with prior urethral bulking. Secondary outcomes were perioperative complications. Regression models were used to evaluate associations between retreatment and perioperative complications while controlling for confounding variables.
Eighty-five patients who underwent MUS placement with prior urethral bulking were identified and matched with 85 control patients who underwent MUS placement without prior urethral bulking. Patients who underwent MUS placement without prior urethral bulking were more likely to have concomitant surgery. Linear regression analysis controlling for the effect of concomitant surgery revealed no difference in estimated blood loss and operative time between the 2 groups. In logistic regression analysis, there was no difference in the retreatment rate and perioperative complications between groups.
We found that the unique treatment combination of MUS placement with prior urethral bulking for recurrent SUI seems to have a similar retreatment rate and perioperative complications as MUS placement without prior urethral bulking.
目前关于经尿道中段吊带（MUS）放置后行尿道内注射治疗复发压力性尿失禁（SUI）的文献有限，且既往有尿道内注射治疗史。
本研究旨在评估与无尿道内注射史的 MUS 放置相比，MUS 放置联合尿道内注射治疗史患者的再治疗和围手术期并发症。
这是一项回顾性队列研究，纳入 2009 年 1 月至 2020 年 12 月期间在美国南加州 Kaiser Permanente 医疗集团接受 MUS 放置的患者。根据年龄和 MUS 手术日期，将行尿道内注射治疗史的患者与无尿道内注射治疗史的对照组以 1:1 比例匹配。主要结局是 MUS 放置联合尿道内注射治疗史患者的 SUI 再治疗。次要结局为围手术期并发症。回归模型用于评估再治疗与围手术期并发症之间的关联，同时控制混杂变量。
共确定了 85 例行 MUS 放置联合尿道内注射治疗史的患者，并与 85 例行 MUS 放置无尿道内注射治疗史的对照组患者相匹配。与无尿道内注射治疗史的对照组患者相比，MUS 放置联合尿道内注射治疗史患者更有可能同时行其他手术。控制了同时手术的影响后，线性回归分析显示两组之间的估计失血量和手术时间无差异。在逻辑回归分析中，两组之间的再治疗率和围手术期并发症无差异。
我们发现，对于复发性 SUI，MUS 放置联合尿道内注射治疗史的独特治疗方案似乎与无尿道内注射治疗史的 MUS 放置具有相似的再治疗率和围手术期并发症。
