There is a debate about the safety and effectiveness of surgical treatments for stress urinary incontinence. Controversy about the use of synthetic mesh sling insertion has led to an increased uptake of retropubic colposuspension and autologous sling procedures. Comparative evidence on the long-term outcomes from these procedures is needed. To compare the risk of reoperation at 10 years after operation between women treated for stress urinary incontinence with retropubic colposuspension, mesh sling insertion, and autologous sling procedures. The records of admissions to National Health Service hosptials were used to identify women who had first-time stress incontinence surgery between 2006 and 2013 in England. The first incidence of the following outcomes was assessed: further stress incontinence surgery, surgery for a complication (either mesh removal, prolapse repair, or incisional hernia repair), and any reoperation (either further stress incontinence surgery, mesh removal, prolapse repair, or incisional hernia repair). The cumulative incidence of each of these outcomes up to 10 years after surgery was calculated, considering death as a competing event. Multivariable modeling was then used to estimate the reoperation hazard ratios for the different initial surgery types with adjustments for patient characteristics and concurrent prolapse surgery or hysterectomy. The analysis included 2262 women treated with retropubic colposuspension, 92,524 treated with mesh sling insertion, and 1234 treated with autologous sling. The cumulative incidence of any first reoperation at 10 years was 21.3% (95% confidence interval, 19.5–23.0) after retropubic colposuspension, 10.9% (10.7–11.1) after mesh sling insertion, and 12.0% (10.2–13.9) after autologous sling procedures. The women who had a retropubic colposuspension were significantly more likely to have a reoperation than women who had an autologous sling (adjusted hazard ratio for any reoperation: 1.79 [1.47–2.17]; for further stress incontinence surgery: 1.64 [1.19–2.26]; for surgery for complications: 1.89 [1.49–2.40]), whereas the women who had mesh slings had a similar hazard (for any reoperation: 0.90 [0.76–1.07]; for further stress incontinence surgery: 0.75 [0.57–0.99]; for surgery for complications: 1.11 [0.89–1.36]). A sensitivity analysis excluding the women who had concurrent prolapse surgery or hysterectomy produced similar results. Retropubic colposuspension is associated with higher risk of reoperation at 10 years after surgery than mesh sling insertion or autologous sling procedures, with 1 in 5 women requiring reoperation.

中文翻译：

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压力性尿失禁手术治疗 10 年后再次手术的风险：一项全国人群队列研究

关于压力性尿失禁手术治疗的安全性和有效性存在争议。关于使用合成网状吊带插入的争议导致耻骨后阴道悬吊术和自体吊带手术的采用率增加。需要关于这些程序的长期结果的比较证据。比较采用耻骨后阴道悬吊术、网状吊带插入术和自体吊带术治疗压力性尿失禁的女性术后 10 年再次手术的风险。国家卫生服务医院的入院记录被用来识别 2006 年至 2013 年间英格兰首次接受压力性尿失禁手术的女性。评估以下结果的首次发生率：进一步压力性尿失禁手术、并发症手术（网片去除、脱垂修复或切口疝修复）以及任何再次手术（进一步压力性尿失禁手术、网片去除、脱垂修复或切口疝修补术）。将死亡视为竞争事件，计算术后 10 年内每种结果的累积发生率。然后使用多变量模型来估计不同初始手术类型的再次手术风险比，并根据患者特征和并发脱垂手术或子宫切除术进行调整。该分析包括 2262 名接受耻骨后阴道悬吊术治疗的女性、92,524 名接受网状吊带插入治疗的女性以及 1234 名接受自体吊带治疗的女性。耻骨后阴道悬吊术后 10 年首次再次手术的累积发生率为 21.3%（95% 置信区间，19.5-23.0），插入网状吊带后为 10.9%（10.7-11.1），自体吊带后为 12.0%（10.2-13.9）程序。接受耻骨后阴道悬吊术的女性比接受自体吊带术的女性更有可能接受再次手术（任何再次手术的调整后风险比：1.79 [1.47–2.17]；进一步压力性尿失禁手术：1.64 [1.19–2.26]；并发症手术：1.89 [1.49–2.40]），而使用网状吊带的女性也有类似的风险（任何再次手术：0.90 [0.76–1.07]；进一步压力性尿失禁手术：0.75 [0.57–0.99]；并发症手术：1.11 [0.89–1.36]）。排除同时进行脱垂手术或子宫切除术的女性的敏感性分析产生了类似的结果。与网状吊带插入或自体吊带手术相比，耻骨后阴道悬吊术后 10 年再次手术的风险更高，五分之一的女性需要再次手术。