四维盆底超声对温针灸联合盆底肌锻炼治疗SUI的疗效评估

目的：通过四维盆底超声观察温针灸联合盆底肌锻炼治疗女性压力尿失禁（SUI）的疗效及优势。方法：筛选70例符合条件的SUI患者，随机分成对照组35例，试验组35例。对照组采用单纯盆底肌锻炼，试验组采用温针灸联合盆底肌锻炼。一月后行疗效评估及经会阴四维盆底超声检查，四维成像得到完整的肛提肌裂孔图像。分别测量治疗前后两组被试静息和Valsava状态下肛提肌厚度(MLT)、肛提肌裂孔左右径（LHW）和面积（LHA）、膀胱颈移动度（BLM），并记录，采用独立样本t检验（P<0.05）。结果：两组被试治疗后临床症状均改善，试验组为著，静息和Valsava状态下MLT增厚、LHW、LHA和BLM减小，试验组更显著，具有统计学差异（P<0.05），LHW差异明显（P<0.01）。结论：温针灸联合盆底肌锻炼更有效提高单纯盆底锻炼治疗SUI的疗效，LHW变化最显著。     

盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁对照观察

目的：探讨盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁的临床疗效和安全性。方法将80例女性压力性尿失禁患者随机分为两组,每组40例,均予以盆底肌锻炼治疗,研究组在此基础上联合度洛西汀治疗,观察8周。采用尿垫试验和尿失禁自我等级评价评定临床疗效。结果治疗8周末,研究组治愈率为86．8％、总有效率为100％,对照组分别为54．1％、70．3％,研究组显著高于对照组（ P＜0．01）;两组尿失禁量及尿失禁自我等级评价评分均较治疗前显著下降（P＜0．01）,研究组较对照组下降更显著（P＜0．01）。研究组偶见轻度头晕、头痛、口干等,且患者可耐受。结论盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁疗效显著,优于单用盆底肌锻炼治疗,值得临床推广应用。     

非侵入式体外磁波治疗妇女尿失禁的临床应用

目的 推荐一种运用体外磁波治疗妇女尿失禁的新疗法，该仪器提供了应用于尿失禁的“非侵犯性”治疗新技术。方法 应用“体外磁波仪治疗女性尿失禁”针对111例压力性、急迫性尿失禁之患者进行治疗。结果 111例患者有47例完成6个月随访，完全治愈13例(28％)，症状改善28例(53％)。对急迫性尿失禁患者也有40％的有效率(4／10)。结论 对照过去多种治疗法，其评比成果获得医学界相当的肯定；也带给医学界，对治疗尿失禁痼疾的一个重大机转。尿失禁系属需长期治疗的顽固症，运用简便而安全的“体外磁波治疗法(ExMI)”患者接受治疗的意愿与配合度较高。因此，作者在此回顾文献中，阐述该项新技术的研发和临床之成果以及该项新治疗法，以期能提高女性尿失禁之治愈和改善率。     

自制吊带经闭孔尿道中段悬吊术治疗压力性尿失禁疗效观察

目的:观察自制吊带行改良经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床效果。方法:50例中、重度压力性尿失禁患者采用聚丙烯网片自制吊带行改良经闭孔无张力吊带尿道中段悬吊术,观察手术情况及术后效果。结果:50例患者手术均成功。平均手术时间11.5±10.1min,术中平均出血量19.9±14.4ml;平均住院7.5±3.3d;无手术并发症发生。随访6-36个月,47例完全治愈,3例有效,有效率100%。无远期并发症,无复发病例。结论:聚丙烯网片自制吊带尿道悬吊术治疗压力性尿失禁疗效确切。     

TVT-O手术治疗女性压力性尿失禁临床疗效的随访分析

目的:探讨经闭孔无张力尿道中段悬吊术(TVT-O)在减少围手术期并发症的同时,是否会降低其远期疗效。方法:测定28例诊断为女性压力性尿失禁(SUI)的患者TVT-O手术后最大尿流率、膀胱残余尿量以及总体手术疗效及其在2年随访期限内的变化。结果:手术前患者最大尿流率为23+11ml/s,手术后1个月为(20.1+9.6)ml/s,较手术前有所下降(P<0.05),经过一段时间后最大尿流率呈线性逐渐恢复到手术前水平。残余尿量手术后先增加然后逐渐稳定。总体手术疗效随手术后随访时间延长有下降趋势,但未发现统计学差异。结论:TVT-O治疗女性压力性尿失禁,在保证较低手术并发症的同时,实现了2年随访期限内基本稳定的治疗效果,是一种理想的治疗方法。     

基质金属蛋白酶与压力性尿失禁关系研究进展

女性压力性尿失禁的发病机制尚不明确,目前研究表明,胶原蛋白作为盆底支持组织细胞外基质的主要成份,在维持盆底支持组织的弹性和韧性中起重要作用.基质金属蛋白酶可降解盆底组织胶原,基质金属蛋白酶组织抑制物能与相应的基质金属蛋白酶特异性结合,抑制其降解作用,基质金属蛋白酶-基质金属蛋白酶组织抑制物家族功能异常可能造成盆底胶原组织降解增加,从而导致压力性尿失禁的发生.     

The safety of the inside-out transobturator approach for transvaginal tape (TVT-O) treatment in stress urinary incontinence: French registry data on 984 women

This study examines the safety of the inside-out transobturator approach for transvaginal tape (TVT-O™, Gynaecare) treatment in stress urinary incontinence (SUI) in women based on a French registry of patients. A total of 984 women from 86 centres were enrolled in the study. Patients with predominant overactive bladder or significant pelvic organ prolapse were excluded from the study. Perioperative and post-operative complications were reported as well as urinary function at 4 and 12 weeks. Pain was assessed by the patients using a visual analog scale (VAS). The overall perioperative complication rate was 2.2%. The most commonly reported morbidities were vaginal wall perforation (1.3%) followed by haematoma (0.7%). Post-operative complication rate was 5.2%; the most common complication was residual pain (2.7%). The other complications of paravesical haematoma, urinary retention, vaginal erosion and re-intervention had an incidence of less than 1.0%. This study demonstrates that the transobturator transvaginal tape approach to the treatment of SUI is a safe procedure.     

The distribution of different surgical types for female stress urinary incontinence among patients’ age,surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers’ characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996–2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.