Schütze Sabine, Behre Joana, Heitmeir Benedikt, Schütze Juliane, Dayan Davut, Janni Wolfgang, Deniz Miriam
Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, DEU.
Applied Science, University of Applied Sciences, Jena, DEU.
Cureus. 2023 Jan 23;15(1):e34072. doi: 10.7759/cureus.34072. eCollection 2023 Jan.
Background and objective The first-line surgical treatment for female stress urinary incontinence (SUI) involves midurethral slings (MUS), including the transobturator tape (TOT) and the retropubic tension-free vaginal tape (TVT). However, whether offering these procedures to older and comorbid women could lead to increased complications is a question that needs to be seriously addressed. In this retrospective cohort study, we aimed to compare the two procedures and evaluate the impact of age, BMI, and comorbidities on complications. Materials and methods A total of 873 procedures (306 TVTs/567 TOTs) performed between 2007 and 2017 were compared and correlated with regard to age, BMI, and comorbidities. Intraoperative complications included bleeding >50 ml, bladder injury, and anesthesia-associated complications. Postoperative complications included post-void residual volume, pain, hematoma, lower urinary tract infection, revision for loosening tape, and bladder infections. The comorbidities were evaluated based on the American Society of Anesthesiologists (ASA) and Charlson scores. Results A total of 873 MUS were conducted during the study period: 306 TVTs and 567 TOTs. Groupwise comparison between these procedures showed that women in the TOT group were older (p<0.001) with a higher BMI (p<0.001) and a higher ASA score (p<0.001) compared to the TVT group. Nevertheless, significantly more intraoperative complications, especially bladder injuries, were recorded in the TVT group. Postoperative complications occurred in 19.4% of the entire cohort, especially increased post-void residual volume. Postoperative hematoma and tape loosening were significantly more frequent in the TOT group. Age, BMI, and comorbidities showed no significant impact on intraoperative complications; however, the TOT procedure was associated with significantly fewer intraoperative complications [p=0.001, odds ratio (OR): 0.281]. Conclusions Overall, both procedures were associated with a low number of perioperative complications. The TOT technique had a lower incidence of intraoperative complications. It must be highlighted that age and comorbidities had no influence on either the intra- or postoperative complication rates. Hence, we recommend that TOT is employed to treat SUI in older, more obese, and comorbid women.
背景与目的 女性压力性尿失禁（SUI）的一线手术治疗包括中段尿道吊带术（MUS），其中包括经闭孔尿道中段吊带术（TOT）和耻骨后无张力阴道吊带术（TVT）。然而，对于老年和患有合并症的女性实施这些手术是否会导致并发症增加是一个需要认真解决的问题。在这项回顾性队列研究中，我们旨在比较这两种手术，并评估年龄、体重指数（BMI）和合并症对并发症的影响。
材料与方法 比较了2007年至2017年间进行的总共873例手术（306例TVT/567例TOT），并将其与年龄、BMI和合并症进行关联分析。术中并发症包括出血>50ml、膀胱损伤和麻醉相关并发症。术后并发症包括排尿后残余尿量、疼痛、血肿、下尿路感染、吊带松动修复和膀胱感染。根据美国麻醉医师协会（ASA）和查尔森评分评估合并症。
结果 在研究期间共进行了873例MUS手术：306例TVT和567例TOT。这两种手术的分组比较显示，与TVT组相比，TOT组的女性年龄更大（p<0.001），BMI更高（p<0.001），ASA评分更高（p<0.001）。然而，TVT组记录的术中并发症明显更多，尤其是膀胱损伤。整个队列中有19.4%发生了术后并发症，尤其是排尿后残余尿量增加。TOT组术后血肿和吊带松动明显更频繁。年龄、BMI和合并症对术中并发症没有显著影响；然而，TOT手术的术中并发症明显较少[p=0.001，优势比（OR）：0.281]。
结论 总体而言，两种手术的围手术期并发症数量都较少。TOT技术的术中并发症发生率较低。必须强调的是，年龄和合并症对术中或术后并发症发生率均无影响。因此，我们建议采用TOT治疗老年、肥胖和患有合并症的女性的SUI。
