Welk Blayne, Winick-Ng Jennifer
Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Urol Pract. 2016 Nov;3(6):475-480. doi: 10.1016/j.urpr.2015.10.004. Epub 2016 Aug 13.
We determined the incidence of stress urinary incontinence surgery performed after mid urethral sling procedures and the impact of physician volume on mid urethral sling failure.
Administrative data were used to identify all women who underwent a mid urethral sling procedure in Ontario, Canada between 2002 and 2013. The primary outcome was subsequent stress urinary incontinence surgery. The primary exposure was surgeon mid urethral sling case volume with high volume defined as greater than the 75th percentile.
A total of 59,556 women with a median age of 52 years (IQR 45-63) received a mid urethral sling, of whom 3.3% underwent additional stress urinary incontinence operations. The most common secondary surgery was a repeat mid urethral sling in 78.3% of cases and a pubovaginal sling in 5.8%. The cumulative incidence of repeat stress urinary incontinence surgery at 10 years of followup was 5.2% (95% CI 4.9-5.5). On multivariable survival analysis the effect of surgeon mid urethral sling volume on subsequent stress urinary incontinence surgery was nonsignificant (HR 0.89, 95% CI 0.76-1.03). Younger patient age, lower comorbidity and simultaneous hysterectomy decreased the hazard of future stress urinary incontinence surgery. In this cohort 1,425 women (2.4%) required surgical revision or removal of the initial mid urethral sling, of whom 215 (15%) underwent a simultaneous or subsequent incontinence procedure. The most common procedure was still a mesh sling, which was placed in 159 women (74.0%).
Secondary stress urinary incontinence surgery after mid urethral sling placement was observed in 3.3% of women. The majority of women with recurrent incontinence were treated with a repeat mid urethral sling. There is a nonsignificant trend toward higher mid urethral sling provider volume being correlated with a reduced risk of future stress urinary incontinence surgery.
我们确定了经尿道中段吊带手术后压力性尿失禁手术的发生率，以及医生手术量对经尿道中段吊带手术失败的影响。
利用行政数据识别2002年至2013年间在加拿大安大略省接受经尿道中段吊带手术的所有女性。主要结局是随后的压力性尿失禁手术。主要暴露因素是外科医生经尿道中段吊带手术量，手术量高定义为高于第75百分位数。
共有59556名年龄中位数为52岁（四分位间距45 - 63岁）的女性接受了经尿道中段吊带手术，其中3.3%接受了额外的压力性尿失禁手术。最常见的二次手术是78.3%的病例重复经尿道中段吊带手术，5.8%的病例行耻骨后阴道吊带术。随访10年时重复压力性尿失禁手术的累积发生率为5.2%（95%置信区间4.9 - 5.5）。多变量生存分析显示，外科医生经尿道中段吊带手术量对随后压力性尿失禁手术的影响不显著（风险比0.89，95%置信区间0.76 - 1.03）。患者年龄较小、合并症较少以及同时行子宫切除术可降低未来压力性尿失禁手术的风险。在该队列中，1425名女性（2.4%）需要对初始经尿道中段吊带进行手术修复或移除，其中215名（15%）同时或随后接受了尿失禁手术。最常见的手术仍是网状吊带，159名女性（74.0%）接受了该手术。
经尿道中段吊带置入术后，3.3%的女性接受了二次压力性尿失禁手术。大多数复发性尿失禁女性接受了重复经尿道中段吊带手术。经尿道中段吊带手术医生手术量较高与未来压力性尿失禁手术风险降低之间存在不显著的趋势。
