女性壓力性尿失禁接受抗失禁手術後需再次手術之早期復發預測因子

楊家誠、劉民慶、郭漢崇、江元宏、張嘉峰、游婉茹、黃子修、李雨霜

花蓮慈濟醫院 泌尿部

Predictive Factors for Early Recurrence Needing Repeat Procedure in Women with Stress Urinary Incontinence after Anti-incontinence Surgery

Chia-Cheng Yang, Min-Ching Liu, Hann-Chorng Kuo, Yuan-Hong Jiang, Jia-Fong Jhang,

 Wan-Ru Yu, Tsu-Hsiu Huang, Yu-Shuang Lee

Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan

Purpose: Anti-incontinence surgery for female stress urinary incontinence (SUI) provides high long-term cure rates; however, a subset of patients experience recurrence requiring repeat intervention. This study aimed to identify predictors of SUI recurrence requiring repeat surgery within 5 years.

Materials and Methods: A total of 560 women with videourodynamic study (VUDS)-confirmed genuine SUI (GSI), with or without pelvic organ prolapse, who underwent anti-incontinence surgery with or without concomitant anterior colporrhaphy and had a follow-up of more than 5 years were included. All patients had intrinsic sphincter deficiency with preserved detrusor contractility. Patients with postoperative voiding difficulty underwent repeat VUDS, and transvaginal urethrolysis was performed if bladder outlet obstruction was suspected. Patients were followed annually, and sling revision was performed in cases of erosion. Recurrent SUI requiring repeat surgery within 5 years was defined as the primary outcome. Baseline VUDS parameters, clinical characteristics, and perioperative factors were analyzed. Logistic regression was used to identify predictors of recurrence.

Results: Among the 560 women, 27 (4.8%) developed recurrent SUI requiring repeat surgery within 5 years. Higher parity (≥5), detrusor underactivity, lower baseline maximum flow rate (Qmax), smaller voided volume, lower voiding efficiency, and lower bladder outlet obstruction index were significantly associated with recurrence. Patients requiring postoperative transvaginal urethrolysis or revision due to sling erosion had a higher risk of recurrence. Among different surgical techniques, transobturator (TOT) sling procedures were associated with inferior long-term success compared with pubovaginal sling and sling combined with anterior colporrhaphy.

Conclusions: Short-term recurrence after anti-incontinence surgery was uncommon (4.8%). Lower baseline Qmax, detrusor underactivity, and postoperative complications were associated with increased recurrence risk. Preoperative urodynamic evaluation may help identify high-risk patients and guide surgical planning.