治療婦女應力性尿失禁，從1970年代盛行的恥骨陰道自體筋膜吊帶手術（使用腹直肌或大腿外側筋膜）開始發展，轉至1990年代開始盛行的人工網膜網膜吊帶手術，對於應力性尿失禁皆有良好療效。而考量人工網膜可能的併發症風險，近期又有越來越多的醫師，重新開始採納自體筋膜吊帶手術。本篇是一超長期追蹤研究，是針對一群接受自體筋膜吊帶手術的應力性尿失禁婦女病換，其手術後平均追蹤14年的成果，在醫學上屬於非常難得的研究成果。

長期追蹤病患實務上非常困難，許多病患可能因治療後成效滿意或其他因素而不再回診。此篇的前身研究為追蹤7年的中期報告，當時共83位個案，已顯示出自體筋膜於中長期時間下的穩定成效，而此篇14年追蹤報告共有34位個案資料可供分析。

研究將個案分成兩組，第一組為使用自體筋膜吊帶手術作為首次尿失禁手術，沒有接受過其他尿失禁手術治療的族群；第二組為應用自體筋膜吊帶手術，作為已接受過其他尿失禁相關手術，手術失敗或產生併發症之補救治療個案。主要應用問卷分數分析，並以UDI-6問卷中第三題：「活動或用力時，是否會漏尿」，回答 0分（沒有）或 1分（沒有／輕微困擾）作為治療成功定義。

研究發現：這34位長期追蹤個案，平均年齡74歲，平均追蹤14.5年，53%符合治療成功定義（第一組：44%；第二組：63%）；與之前追蹤7年成果比較，尿失禁問卷各項分數沒有差異。而對於自體筋膜吊帶手術應用於首次或挽救性治療，原預期作為挽救性治療可能效果較差，但兩組病患治療效果於長期追蹤下也沒有差異。

自體筋膜吊帶由於是使用自身組織，學理上有較高的組織相容性，所以當病患的情況較為複雜時，如已有人工網膜曝露、會陰部接受過放射治療、長期使用類固醇、同時須處理廔管、憩室等情況，選擇自體筋膜吊帶應是更佳選擇，也有部分醫師使用此種手術作為第一選擇。而此篇研究提供，提供自體筋膜吊帶手術之長期治療效果，雖然明顯的偏誤是有一半以上的個案失去追蹤，文中指出這些個案平均居住距離距醫院較遠，但仍是很有參考價值的文章。

Introduction and hypothesis: The objective was to report on the very long-term outcome of a published series of autologous pubovaginal slings (PVS) in women with stress urinary incontinence (SUI).

Methods: Following institutional review board approval, a cohort of well characterized, non-neurogenic women who underwent an autologous PVS (primary [PVS1] and secondary [PVS2]) for SUI was re-evaluated for their very long-term outcome status. Data collected included demographics, validated questionnaires (Urogenital Distress Inventory - short form [UDI-6], Incontinence Impact Questionnaire - short form 7, quality of life), SUI retreatment/operations, and subjective patient-reported SUI improvement (%) and symptom recurrence. The primary outcome was success defined as UDI-6 question 3 (SUI) ≤ 1 and no SUI retreatment/operation. Patients not seen in clinic for 2 years were contacted via a standardized phone interview.

Results: From 83 patients with 7-year intermediate follow-up data, 34 (PVS1 = 18, PVS2 = 16) had very long-term follow-up based on clinic visit (7) or phone interviews (27). Those lost to follow-up (49), including 5 deceased, did not differ in demographics and intermediate outcomes from the followed cohort, but lived further away (>75 miles). At a mean age of 74 years, and with a median follow-up of 14.5 years, 53% met the success criteria (PVS1 = 44%, PVS2 = 63%). Mean postoperative questionnaire scores did not differ significantly between intermediate and very long-term follow-ups, and long-term outcomes between PVS1 and PVS2 remained similar.

Conclusions: A majority of women with long-term follow-up after PVS for primary and secondary SUI remained successful more than 14 years after their surgery. Both groups, PVS1 and PVS2, fared equally well, confirming the durability of PVS as a treatment alternative for SUI.