无张力性阴道吊带治疗女性压力性尿失禁的临床疗效

目的　探讨无张力性经阴道尿道中段吊带术(TVT)治疗女性压力性尿失禁(SUI)的临床疗效。　方法　对42例压力性或混合性尿失禁的女性患者进行了TVT手术治疗。年龄31 ~69岁,平均48岁,病程3 ~21年。行腹压漏尿点压(ALPP)测定。按照McGurire的方法分型,ALPP>9. 81kPa(Ⅰ型)8例,ALPP6. 38~9. 81kPa(Ⅱ型)12例,ALPP<6. 38kPa(Ⅲ型)22例。　结果　平均手术时间40min(30~90min),平均术后住院4. 5d(3 ~8d)。42例随访4 ~18个月,平均15个月,无SUI复发, 34例单纯性SUI患者治愈32例,治愈率94. 1%,显效2例(5. 9% ); 8例混合性尿失禁患者中治愈7例,显效1例。术后发生尿潴留4例, 1例作松解术, 3例延长导尿管留置后缓解。42例术后均无尿失禁。　结论　TVT是治疗女性SUI安全有效的方法,手术安全易行,创伤小,康复快,近期效果满意。     

无张力阴道吊带术治疗女性压力性尿失禁(附20例报告)

目的 评价无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法 总结采用TVT术治疗女性压力性尿失禁20例的临床资料。结果 平均手术时间26.5min。拔除尿管后，19例病人控尿满意，1例仍有轻微尿失禁。术后平均随访12(3-24)个月，20例病人均无尿失禁。合并症有1例膀胱穿孔，1例术后轻度排尿不畅，2例尿频尿急。结论 TVT术操作简便快捷，创伤小，合并症少，术后康复快，是一种治疗女性压力性尿失禁的理想方法。     

中段尿道吊带术治疗女性压力性尿失禁的多中心研究

目的 探讨中段尿道吊带术治疗女性压力性尿失禁的临床疗效、手术指征和并发症的处理.方法 单纯压力性尿失禁的患者304例和混合性尿失禁的患者8例,均为女性,纳入本研究.其中接受TVT吊带术134例,TVTO吊带术167例,Monarc吊带术11例.围手术期评估包括:手术时间、出血量、术中术后并发症.手术效果分为治愈、显效、无效.在患者出院时、术后3个月、术后每年评价疗效和并发症.结果 TVT组手术时间(18.5±9.6)min和出血量(32.2±12.6)ml多于TVTO组(11.5±3.1)min,(12.8±8.5)ml和Monarc组(11.1±2.6)min,(12.3±3.5)ml(P<0.05).三种术式均有较高的治愈率和显效率,不同术式的近期和中长期治愈率、显效率和无效率差异无统计学意义(P>0.05).单纯压力性尿失禁患者治愈率(95.7% )显著高于混合性尿失禁患者(37.5% )(P<0.01).3种术式的总并发症发生率差异无统计学意义,但膀胱损伤仅发生在TVT组,闭孔神经损伤和阴道损伤仅发生在TVTO组.术后排尿困难和尿潴留是中段尿道吊带术的最常见并发症.结论 经耻骨上途径(TVT)和经闭孔途径(TVTO、Monarc)中段尿道吊带术治疗压力性尿失禁均具有手术简单、微创、中长期疗效好、并发症少等优点.     

经阴道无张力性尿道中段悬吊术治疗女性压力性尿失禁10例分析

目的：探讨经阴道无张力性尿道中段悬吊术(TVT)在治疗女性压力性尿失禁中的意义。方法：10例患者，年龄45—58岁，平均48．4岁。临床表现为用力、咳嗽等时尿液不自主流出。病史4个月-15年。经详细地尿动力学检查证实为压力性尿失禁。行腹压漏尿点压(abdominal leak-point pressure，ALPP)测定，按照McGuire的方法分型，ALPP＞9．81kPa(I型)2例，ALPP6．38—9．81kPa(Ⅱ型)3例，ALPP＜6．38kPa(Ⅲ型)5例。结果：术后10例均无尿失禁，8例患者拔除导尿管当日即可顺利排尿，1例出现尿潴留，1例膀胱穿孔。结论：TVT手术安全易行，手术时间短，创伤小，患者康复快，治疗压力性尿失禁近期效果确切，远期疗效有待进一步研究。     

无张力阴道吊带术微创治疗女性压力性尿失禁

目的:评价无张力阴道吊带术(TVT)治疗女性压力性尿失禁的疗效。方法:对女性压力性尿失禁患者18例,经临床和尿动力学检查确诊,均为稳定性膀胱,无膀胱出口梗阻。采用TVT术,将吊带无张力置于尿道中段。结果:手术时间平均(40±6)min;术中出血量平均(43±11) ml;术后平均留置导尿1.5d;术后平均住院3d。18例患者术后尿失禁症状均消失。1例患者术后出现尿潴留,留置导尿1 周后好转,尿潴留症状消失,尿失禁未复发。结论:TVT手术因其简单,微创,疗效好,并发症少,目前可作为女性压力性尿失禁手术治疗的首选术式。     

无张力阴道吊带治疗女性压力性尿失禁10例报告

目的　评价无张力阴道吊带 (TVT)治疗女性压力性尿失禁中的临床疗效。方法　对 10例女性压力性尿失禁患者进行TVT术治疗 ,并对手术疗效进行随访。结果　 1例术中出现膀胱穿孔 ,2例拔管后出现尿潴留 ,经延长导尿管留置时间后缓解 ,所有患者尿失禁症状完全消失 ,随访 2～ 12个月 ,无尿失禁复发。结论　TVT术治疗女性压力性尿失禁具有创伤小、效果好、并发症少、安全性高的优点 ,值得推广应用。     

改良的无张力尿道中段悬吊术治疗女性压力性尿失禁疗效观察

目的：观察改良的无张力尿道中段悬吊术（Tensionfree viginaI tape,TVT）治疗女性压力性尿失禁的效果。方法：采用改良的TVT治疗女性压力性尿失禁患者26例。结果：26例患者术后压力性尿失禁完全消失,平均手术时间36min,平均出血量45ml,术中未见膀胱损伤、大出血、血肿及神经损伤。结论：改良的TVT手术创伤小,悬吊疗效可靠,且价格低廉,易为患者接受。     

无张力阴道吊带术治疗女性压力性尿失禁(附13例报告)

目的　评价无张力阴道吊带术 (TVT)治疗女性压力性尿失禁疗效。　方法　女性压力性尿失禁患者 13例 ,经临床和尿动力学检查确诊 ,均为稳定性膀胱 ,膀胱出口无梗阻。采用Prolene聚丙烯网状吊带 ,手术自阴道前壁切口经耻骨后向下腹部穿刺 ,将吊带无张力置于尿道中段。　结果　手术时间平均 (38± 7)min ;术中出血量平均 (4 5± 10 )ml;术后平均留置导尿 2d ;术后平均住院 4d。13例患者术后尿失禁症状均消失。 1例患者术后出现尿潴留 ,留置导尿 2周后无改善 ,予手术切断吊带 ,尿潴留症状消失 ,尿失禁未复发。　结论　TVT手术疗效确切 ,操作简便 ,对患者损伤小 ,并发症发生率低 ,是一种治疗女性压力性尿失禁的有效方法。     

经阴道无张力尿道悬吊带治疗女性压力性尿失禁(附37例报告)

目的 探讨经阴道无张力尿道悬吊带(Tension-free vaginal tape，TVT)方法治疗女性压力性尿失禁的临床疗效。方法 采用TVT术式治疗女性压力性尿失禁患者37例。利用弧形Trocar穿刺针将TVT从阴道前壁切口放置于尿道中段下方，术后24h拔除导尿管自行排尿。结果 2例患者拔除导尿管后出现急性尿潴留，经扩张尿道，保留导尿后恢复正常排尿。37例随访3-16个月，平均13个月，无尿失禁复发。结论 TVT治疗女性压力性尿失禁疗效满意，手术简单，安全可靠，无严重并发症。     

无张力阴道吊带术治疗压力性尿失禁

目的探讨TVT手术作为治疗女性压力性尿失禁新手术方法的有效性.方法回顾性分析自2002年10月以来应用TVT手术治疗4例女性压力性尿失禁的临床疗效及并发症.结果4例压力性尿失禁患者接受TVT手术,术后排尿功能恢复良好,1例发生排尿困难,经持续导尿及药物治疗后恢复正常排尿功能.结论TVT手术具有简单、微创、恢复快等特点,是治疗女性压力性尿失禁的安全有效方法.     

Tension-free vaginal tape for surgical treatment of stress urinary incontinence: Two years follow-up

BACKGROUND: The objective was to study prospectively the effectiveness of tension-free vaginal tape as an ambulatory and minimal invasive operation for the treatment of female stress incontinence. METHODS: The tension-free vaginal tape procedure was performed in 25 patients with genuine stress incontinence and they were followed for a 2-year period. All patients were diagnosed with urodynamics to have genuine stress incontinence. Pad tests, cough stress test and quality-of-life assessments were carried out in all patients, both preoperatively and postoperatively. The majority of the women were discharged the morning after the surgical procedure. RESULTS: Twenty of 25 (80%) patients were found to be cured 2 years after the operation. The vaginal tape was spontaneously dropped out from the vagina in one patient 2 weeks after the procedure. We did not see such a complication in previous studies. CONCLUSION: We conclude that the tension-free vaginal tape procedure is both a safe and effective method to cure genuine female stress incontinence. Furthermore, it can be performed as an ambulatory procedure under local anesthesia with a short operative time.     

The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence

Since 1994, over 100,000 surgical reconstructions of the female lower urinary tract have been performed worldwide using tension-free vaginal tape (TVT). This technique, which differs from traditional methods, is effective against symptoms of stress urinary incontinence and may be performed as an ambulatory procedure with no need of indwelling catheterization. The primary indication is genuine stress incontinence, but it is also effective as a secondary procedure for relapse after other anti-incontinence measures such as the Burch procedure. The TVT operation was developed according to study results on the mechanisms of urethral closure in women and has become the primary surgical procedure at several Scandinavian clinics for combating genuine stress incontinence in women. It is also useful in reducing symptoms after prolapse repair for combined prolapse and stress incontinence and in cases of mixed stress and urge ("sensory") incontinence. The small incisions and canals involved with the TVT technique minimize surgical trauma and enable it to be performed under local anesthesia. By the same token, it makes fairly small demands on postoperative care and attendant costs. Here we describe the instrumentation, procedure, and risks of this minimally invasive operative technique.     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。     

Results of the tension-free vaginal tape procedure for the treatment of type II stress urinary incontinence at a minimum followup of 1 year

PURPOSE: We evaluated the safety and efficacy of the tension-free vaginal tape procedure for treating type II stress urinary incontinence in females. MATERIALS AND METHODS: Between April 1998 and April 1999, 62 women 28 to 86 years old (mean age 62.8) were treated consecutively for stress urinary incontinence with the tension-free vaginal tape procedure. Preoperative evaluation included history, physical examination and multichannel video urodynamics. All patients had type II stress urinary incontinence, none had preoperative detrusor instability or significant pelvic prolapse and in 16 previous surgery for stress incontinence had failed. RESULTS: All patients were followed at least 12 months after the procedure (median 16.2). A total of 42 and 20 women received spinal and local anesthesia, respectively. We noted 6 bladder perforations, including 5 in patients with a history of surgery for stress urinary incontinence. Blood loss was less than 200 cc in all cases. We observed no prolonged postoperative pain, infection or sling rejection. Post-void residual urine was less than 100 cc the day after surgery in 59 cases. Only 3 patients self-catheterized a maximum of 4 days. At followup 54 women (87.1%) were cured of stress urinary incontinence, 6 were improved (9.6%) and 2 had failure (3. 3%), while 4 (6.4%) had new onset detrusor instability without evidence of bladder outlet obstruction. CONCLUSIONS: The tension-free vaginal tape procedure appears to be a minimally invasive, safe and effective treatment for type II stress urinary incontinence. A history of surgery for stress incontinence seems to be a risk factor for bladder perforation.     

四种吊带手术经腹壁或闭孔固定治疗女性压力性尿失禁的效果比较

目的:探讨四种吊带手术经腹和闭孔途径治疗女性压力性尿失禁的效果.方法:采用人工合成材料的吊带经腹壁固定方式(TVT和IVS技术)治疗女性压力性尿失禁患者23例;用经闭孔固定方式(TOT和TVTO技术)治疗女性真性压力性尿失禁患者16例.并进行疗效比较.结果:绝大多数患者均排尿通畅,无尿失禁复发.但TVT组中有1例排尿不畅,3个月后剪断吊带后变为轻度尿失禁;有1例术中膀胱穿孔,术后停留导尿管1周.结论:用四种吊带手术治疗女性真性压力性尿失禁安全、微创和有效.经闭孔固定技术和用经腹壁固定技术这两种方法各有自己的优缺点.     

The tension-free vaginal tape procedure in women with previous failed stress incontinence surgery.

PURPOSE: The tension-free vaginal tape procedure is an increasingly popular choice for treating female urinary stress incontinence. This ongoing, prospective, open label study presents the results of tension-free vaginal tape surgery at 1 year in women who have previously undergone unsuccessful stress incontinence surgery. MATERIALS AND METHODS: A total of 67 women with previous failed surgery for stress urinary incontinence underwent the tension-free vaginal tape procedure. Treatment outcome was categorized as cure, significant improvement or failure based on cystometry findings and urinary pad loss results at 3 months of followup, and on subjective questioning at 3 months and 1 year of followup. RESULTS: At 12 months 54 women (81%) were cured, 4 (6%) were significantly improved and 9 (13%) were no better. No serious morbidity was noted after the procedure. CONCLUSIONS: The tension-free vaginal tape procedure provides the prospect of a success rate similar to that of a conventional sling procedure in patients with previous failed surgery. It has a low rate of operative complications and postoperative morbidity.     

A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence

The aim of the study was to evaluate the safety and efficacy of TVT (tension-free vaginal tape) for the surgical treatment of stress urinary incontinence. The design was a prospective open multicenter study including six centers, each operating an approximately 20 patients. In total 131 patients suffering from genuine stress incontinence were included. They were followed for at least 1 year using a specific protocol for objective and subjective evaluation of the outcome. All patients underwent the operation under local anesthesia. Mean operation time was 28 minutes (range 19–41 minutes); 119 (91%) of the patients were cured according to the protocol and another 9 (7%) were significantly improved. There were 3 (2%) failures. The majority of the patients (about 90%) were operated upon on a day-care basis, which implied that they were released from the hospital within 24 hours, with no postoperative catheterization. No defect healing and no tape rejection occurred. Three patients needed an indwelling catheter for 3 days. In 1 patient catheterization was necessary for more than 10 days. Two uncomplicated hematomas and one uncomplicated bladder perforation occurred. Based on the results, we conclude that TVT is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence.Editorial Comment: This is the first prospective study of a relatively new and minimally invasive surgical procedure for stress urinary incontinence. The authors are to be complimented on the fact that they went out into the community hospitals in their area to see if their results could be reproduced by the average practicing gynecologist. Also, it is good to see that the investigators used a validated quality of life assessment to provide very important follow-up information on the improvement in the patient's quality of life, as this should be the basic tenet of all therapies for urinary incontinence. However, many questions remain regarding the diagnostic criteria they used in selecting their patients, as well as the degree of testing performed postoperatively. Further study is needed to confirm the results found here with a very new and interesting technique in the surgical treatment of stress incontinence.     

Comparison of two inside‐out transobturator suburethral sling techniques for stress incontinence: Early postoperative thigh pain and 3‐year outcomes

Objectives: Inside‐out tension‐free vaginal tape obturators for the cure of female stress incontinence can cause postoperative thigh pain. The aim of the present study was to analyze and compare the mid‐term outcomes of two tension‐free vaginal tape obturator procedures. Methods: Patients diagnosed with urinary stress incontinence were enrolled to undergo a tension‐free vaginal tape obturator sub‐mid urethral tape operation either by de‐Leval's method or by Flam's modification. Peri‐ and postoperative data were collected by uninvolved researchers and analyzed. Follow up was 36 months. Results: Overall, 161 patients were included in the study. Cure and complication rates were similar between the two treatment groups. Postoperative thigh pain was significantly more frequent and lasted longer in the de‐Leval group compared with the Flam group (31.9% vs 10.0%, respectively). Urinary urgency was more frequent in the de‐Leval patients (20.3% vs 2.8%). Conclusion: Our findings suggest that both tension‐free vaginal tape obturator procedures are effective with few adverse effects. The Flam method provides shorter and decreased levels of postoperative thigh pain, as well as reduced long‐term postoperative urinary urgency.     

Tension-free vaginal tape procedure for the treatment of mixed urinary incontinence: significance of maximal urethral closure pressure

PURPOSE: We investigated factors predicting persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence. MATERIALS AND METHODS: Between March 1999 and May 2003 female patients with complaints of urinary incontinence were evaluated according to our protocol. After the tension-free vaginal tape procedure patients were followed at 1, 6 and 12 months, and yearly thereafter. A total of 274 women (stress urinary incontinence in 201 and mixed urinary incontinence in 73) with followup at least greater than 6 months were included in the study. The cure of stress induced incontinence after the procedure was defined as an absent subjective complaint of leakage and objective leakage on stress testing. All other cases were considered failures. RESULTS: There was no significant difference in the cure rate for stress induced incontinence between patients with stress and mixed urinary incontinence. However, 12 of 73 patients (16.4%) with mixed urinary incontinence had persistent urge incontinence. Thus, the overall cure rate was significantly higher in the stress incontinence group than in the mixed incontinence group (95.5% vs 78.1%, p <0.001). On multivariate analysis maximal urethral closure pressure was associated with a 0.9-fold risk of persistent urge incontinence after the procedure in patients with mixed urinary incontinence (OR 0.94, 95% CI 0.88 to 0.99, p = 0.030). CONCLUSIONS: Our findings suggest that low maximal urethral closure pressure may be associated with persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence.