Patel Tirath, Sugandh Fnu, Bai Shuaita, Varrassi Giustino, Devi Anjuli, Khatri Mahima, Kumar Satesh, Dembra Deepak, Dahri Samiullah
Surgery, American University of Antigua, St John, ATG.
Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK.
Cureus. 2023 Apr 18;15(4):e37773. doi: 10.7759/cureus.37773. eCollection 2023 Apr.
Stress urine incontinence (SUI) is most common in middle-aged women and the second most common in those over 75. SUI causes significant discomfort and suffering for patients and has a considerable financial impact on the healthcare system. Conservative approaches are recommended as the first step in treatment. However, surgery is often necessary to improve a patient's quality of life due to the high failure rate of conservative treatments. A thorough literature review of studies published before March 2023 was conducted on the safety and effectiveness of single-incision mini slings (SIMS) and standard mid-urethral slings (MUS). PubMed, Embase, Cochrane Library, and Elsevier's ScienceDirect were used to retrieve the studies. Two reviewers independently searched and evaluated the data based on inclusion and exclusion criteria. Review Manager 5.4 software was used for meta-analysis. Included were seventeen studies involving 3,503 female SUI patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence. According to the results of our meta-analysis, the clinical efficacy of SIMS is comparable to that of MUS in terms of objective cure rate (RR: 0.99; 95% CI: 0.95 to 1.03, p: 0.66, I2: 29%). In contrast, it increases the post-procedure International Consultation on Incontinence Questionnaire (ICIQ) score (WMD: 0.08; 95% CI: -0.08 to 0.08). CI: -0.02 to 0.18, p: 0.11, I2: 55%) and improves the PGI-I score to a greater extent (RR: 1.04; 95% CI: 0.96 to 1.08, p: 0.36, I2: 76%). In contrast, there is no difference between the two groups regarding patient satisfaction (RR: 0.96; 95% CI: 0.92 to 1.01, p: 0.16, I2: 0%) and Sandvik score reduction (RR: 0.98; 95% CI: 0.94 to 1.02, p: 0.35, I2: 0%). In conclusion, single-incision mid-urethral slings (SIMS) are as effective as mid-urethral slings (MUS) for treating pure stress urinary incontinence (SUI) without intrinsic sphincter deficiency (ISD), with a shorter operation time. However, the SIMS procedure has a higher incidence of dyspareunia. At the same time, bladder perforation, mesh-related complications, pelvic/groin pain, urinary tract infection (UTI), worsening urgency, dysuria, and pain score are less likely to occur with SIMS. Only the decrease in pelvic/groin pain was statistically significant.
压力性尿失禁（SUI）在中年女性中最为常见，在75岁以上人群中排第二常见。SUI给患者带来极大不适和痛苦，对医疗保健系统造成相当大的经济影响。保守治疗方法被推荐为治疗的第一步。然而，由于保守治疗的高失败率，手术往往是改善患者生活质量所必需的。对2023年3月之前发表的关于单切口微型吊带（SIMS）和标准中段尿道吊带（MUS）的安全性和有效性的研究进行了全面的文献综述。使用PubMed、Embase、Cochrane图书馆和爱思唯尔的ScienceDirect检索研究。两名评审员根据纳入和排除标准独立搜索和评估数据。使用Review Manager 5.4软件进行荟萃分析。纳入了17项研究，涉及3503名无内在括约肌缺陷（ISD）或混合性尿失禁的女性SUI患者。根据我们的荟萃分析结果，就客观治愈率而言，SIMS的临床疗效与MUS相当（RR：0.99；95%CI：0.95至1.03，p：0.66，I2：29%）。相比之下，它会增加术后国际尿失禁咨询问卷（ICIQ）评分（WMD：0.08；95%CI：-0.08至0.08）。CI：-0.02至0.18，p：0.11，I2：55%），并在更大程度上改善PGI-I评分（RR：1.04；95%CI：0.96至1.08，p：0.36，I2：76%）。相比之下，两组在患者满意度（RR：0.96；95%CI：0.92至1.01，p：0.16，I2：0%）和桑德维克评分降低方面没有差异（RR：0.98；95%CI：0.94至1.02，p：0.35，I2：0%）。总之，单切口中段尿道吊带（SIMS）在治疗无内在括约肌缺陷（ISD）的单纯压力性尿失禁（SUI）方面与中段尿道吊带（MUS）一样有效，且手术时间更短。然而，SIMS手术性交困难的发生率较高。同时，SIMS发生膀胱穿孔、网片相关并发症、盆腔/腹股沟疼痛、尿路感染（UTI）、尿急加重、排尿困难和疼痛评分的可能性较小。只有盆腔/腹股沟疼痛的减轻具有统计学意义。
