Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Female Pelvic Medicine, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Int Urogynecol J. 2024 Apr;35(4):849-854. doi: 10.1007/s00192-024-05731-5. Epub 2024 Feb 20.
Retropubic midurethral sling (MUS) placement is the gold standard for the treatment of stress urinary incontinence in the USA. The procedure can be approached from either a top-down or a bottom-up direction, but there is a paucity of contemporary data regarding outcomes between these approaches. The aim of this study was to provide updated clinical outcomes data.
This was a retrospective cohort study of women undergoing the retropubic MUS procedure alone or at the time of pelvic organ prolapse repair between 2010 and 2020 at a single academic medical center. The electronic medical record was used to extract demographic data, operative approach, and perioperative complications. The primary outcome was a composite incidence of any perioperative complication.
Of the 309 patients analyzed, 140 (45.3%) underwent top-down and 169 (54.7%) underwent bottom-up retropubic MUS placement. Patients undergoing top-down MUS placement were more likely to be older (mean age 58 vs 54, p=0.02), have a history of diabetes mellitus (20% vs 8.9%, p=0.004), and have had a prior hysterectomy (27% vs 16%, p=0.02). They were less likely to have a concurrent anterior (p<0.001) or posterior repair (p<0.001). Patients undergoing the top-down procedure were less likely to experience sling exposure (p=0.02); complications in the two groups were otherwise similar.
The top-down approach to retropubic MUS placement was associated with lower rates of mesh erosion in this population of patients. Neither approach is associated with an increased overall risk of complications or de novo overactive bladder symptoms.
经耻骨后尿道中段吊带（MUS）放置是治疗美国压力性尿失禁的金标准。该手术可以从上到下或从下到上进行，但关于这两种方法的结果，目前的数据很少。本研究的目的是提供最新的临床结果数据。
这是一项回顾性队列研究，纳入 2010 年至 2020 年期间在一家学术医疗中心单独或同时行经耻骨后 MUS 手术和盆腔器官脱垂修复术的女性。电子病历用于提取人口统计学数据、手术方法和围手术期并发症。主要结局是任何围手术期并发症的综合发生率。
在分析的 309 名患者中，140 名（45.3%）行从上到下的耻骨后 MUS 放置，169 名（54.7%）行从下到上的耻骨后 MUS 放置。行从上到下 MUS 放置的患者更可能年龄较大（平均年龄 58 岁 vs 54 岁，p=0.02），有糖尿病病史（20% vs 8.9%，p=0.004），并曾行子宫切除术（27% vs 16%，p=0.02）。她们不太可能同时行前修补术（p<0.001）或后修补术（p<0.001）。行从上到下手术的患者更可能出现吊带暴露（p=0.02）；但两组的并发症相似。
在本患者人群中，经耻骨后 MUS 从上到下放置的方法与较低的网片侵蚀率相关。两种方法都不会增加总体并发症风险或新发膀胱过度活动症症状。
