女性經恥骨後尿道懸吊手術與併行之骨盆脫垂手術有無之長期療效追蹤
李秉叡、郭漢崇
花蓮慈濟醫院暨慈濟大學泌尿部
The long term efficacy between women with pelvic floor dysfunction received retropubic suburethral sling with or without concomitant POP repair
Ping-Jui Lee, Hann-Chorng Kuo
Divisions of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

 

Purpose: To distinguish the long-term efficacy between retropubic suburethral sling with and without concomitant pelvic organ prolapse repair for female pelvic floor dysfunction.

Materials and Methods: This is a single center retrospective cohort study from September, 1997 to December, 2018 in the Hualien Tzu Chi Hospital, Taiwan. Women who received pubovaginal sling (PVS) for stress urinary incontinence (SUI) with or without concomitant anterior colporrhaphy, posterior colporrhaphy, transobturator tape sling (TOT, Avaulta Solo®) for pelvic organ prolapse (POP) in the preceding 21 years were retrospectively reviewed. Baseline demographic characteristics, post-operative follow-up times, continence-specific surgical results, surgical revision rate and types were analyzed through chart review and phone interview. The successful outcome of the surgery was defined as dryness without SUI and dysuria. In contrast, subjective SUI and dysuria were both labeled as failure. Kaplan-Meier curve was used to assess time to subjective surgical event between two groups.

Results: A total of 614 consecutive women with 643 times of surgery and mean follow-up of 62.8 months were enrolled in this study. There were 456 times of pubovaginal sling alone and 187 times of pubovaginal sling with concomitant POP repair. The mean age at the time of surgery of the two groups were 59.4±11.6 years (range 20 to 89) and 64.8±10.5 years (range 34 to 89). Significant elder age was observed in the PVS with concomitant POP repair group (P=0.000). The other baseline characteristics were statistically significant difference in the PVS with concomitant POP repair group, including greater parity, and higher menopausal status than the PVS alone group as well (P=0.008 and 0.005, respectively). The overall subjective failure rate was 33.3% and 32.6% in the PVS alone group and the PVS with concomitant POP repair group, respectively (P=0.820). There were 51 (11.2%) and 15 (8.0%) patients with subjective SUI or dysuria after the surgery received surgical revision in the PVS alone group and the PVS with concomitant POP repair group. They both showed no statistically difference in the continent-specific surgical revision rate and type. The Kaplan-Meier time to subjective event analysis indicated that there was no significant difference of survival between two groups (Log-rank test P=0.872). The mean survival time for PVS alone group was 10.4 years and the median survival was 11.3 years (95%CI: 8.3-14.2). The mean survival time for PVS with concomitant POP repair group was 9.8 years and the median survival was 12.8 years (95%CI: 7.7-17.8)

Conclusions: The overall subjective failure rate was 33.3% and 32.6% in the PVS alone group and the PVS with concomitant POP repair group, respectively. No statistically difference in the continent-specific surgical revision rate and type were obtained. They both have a durable long-term efficacy for women SUI with and without concomitant POP.