Solyx单切口悬带系统治疗女性压力性尿失禁临床效果

目的:探讨Solyx单切口悬带系统治疗女性压力性尿失禁(SUI)的安全性与有效性.方法:选取2019年11月至2020年3月在郑州大学附属郑州中心医院妇科因SUI行Solyx单切口阴道无张力尿道中段悬吊术的32例患者.统计手术时间、出血量、拔出尿管时间等围术期情况;术后1周、1月、3月和6月常规随访排尿及并发症情况,术...     

女性压力性尿失禁的综合治疗

目的:探讨女性压力性尿失禁(stressurinaryincontinence,SUI)的治疗方法和效果。方法:压力性尿失禁51例采用经阴道无张力尿道中段悬吊带术治疗23例,药物和功能训练治疗28例。结果:手术治疗组23例手术时间平均35min,出血量平均15ml,随访患者3~23月, 21例(91 .3% )治愈, 2例明显改善。4例出现并发症,其中术中膀胱损伤3例,术后尿潴留1例。非手术治疗28例2例治愈, 18例有不同程度地改善, 8例无效,总有效率为71 .4%。结论:经阴道无张力尿道悬吊带术是治疗女性压力性尿失禁十分有效的微创方法,药物治疗和功能训练有一定的改善作用。     

单切口经阴道无张力尿道中段悬吊带术TVT-Secur治疗女性压力性尿失禁前瞻性研究

目的:评估单切口经阴道无张力尿道中段悬吊带术(TVT-Secur)治疗女性压力性尿失禁术后2年的疗效。方法:对经尿动力学检查证实为压力性尿失禁同时伴有不同程度的阴道后壁膨出的21例患者,行单切口经阴道无张力尿道中段悬吊带术及阴道后壁修补术治疗,记录围手术参数、疼痛评分及并发症,并随访了术后2年内的临床效果。结果:实行TVT-Secur手术的21例患者均在静脉麻醉下完成;平均手术时间9.7min;平均术中出血量36.9ml;患者均在术后24h内自行排尿,19例(91%)残余尿为0,2例(9%)残余尿<50ml。术后视觉模拟疼痛评分(VAS)均<3分,平均1.86分。术中有3例发生阴道壁穿透,无术后并发症及术后病率。术后以患者主观感觉和客观尿垫试验为评价标准,平均随访17.3个月,主观治愈率95.2%(20/21),客观治愈率85.7%(18/21),改善率9.5%(2/21)。结论:单切口经阴道无张力尿道中段悬吊带术是治疗女性压力性尿失禁微创、低疼痛和安全的手术方法,近期疗效满意。     

阴道无张力尿道中段悬吊术治疗压力性尿失禁34例临床分析

目的　评估阴道无张力尿道中段悬吊 (TVT)术治疗女性压力性尿失禁术后近 2年的疗效。方法　对 34例经尿动力学检查证实为压力性尿失禁同时伴有不同程度的阴道前壁膨出患者 ,行TVT术及阴道前壁修补术治疗 ,并对术后 2年内的效果进行随访。结果　 33例患者TVT手术均在局部麻醉加静脉麻醉下完成 ;平均手术时间 2 6 .9min ;术中出血量平均 2 9.8ml;30例 (88% )患者在术后 12h内自行排尿 ,残余尿 <10 0ml;另 4例 (12 % )患者术后需短暂保留尿管。平均住院 2 .9d ,30例 (88% )患者住院 2d以内 ;术后以患者主观感觉评价 ,平均随访 8.3个月 ,32例 (94 % )主观完全治愈 ,2例 (6 % )为明显改善 ,无一例无效 ;手术并发症少。结论　TVT术是治疗女性压力性尿失禁微创、有效和安全的手术方法之一     

经闭孔阴道无张力尿道中段悬吊带术治疗女性压力性尿失禁的远期结局及进展

压力性尿失禁(SUI)是影响女性身心健康的常见疾病,有多种治疗方法,其中阴道无张力尿道中段悬吊带术是一线手术治疗SUI的常用方法,目前临床上多选择闭孔路线。经闭孔从外向内穿刺的无张力尿道中段吊带术(TOT)及经闭孔从内向外穿刺的无张力尿道中段吊带术(TVT-O)安全性高、手术时间短、疗效好、并发症少,可显著提高SUI患者的生活质量、维持或改善性功能,且膀胱穿孔、肠管损伤及排尿功能障碍等围手术期并发症的发生率均较低。经闭孔路径悬吊带术(包括TVT-O和TOT)的特有并发症为下肢疼痛,可以通过药物治疗或随着时间推移减轻症状。     

女性压力性尿失禁伴膀胱膨出27例手术治疗结局

本研究采用治疗压力性尿失禁（SUI）的经阴道尿道中段悬吊（intravaginal slingplasty，IVS或童式前路悬吊术，Tong’s hammock anterior）及治疗膀胱膨出的阴道前壁“桥式”修补术，治疗27例压力性尿失禁伴膀胱膨出患者，取得较好近中期疗效，现报道如下。     

非重度妊娠期高血压、子痫前期终止妊娠时机和方式的探讨

目的:分析经闭孔无张力尿道中段悬吊术（TVT-O）后复发性压力性尿失禁（SUI）女性患者的临床特点和治疗。方法:回顾性分析2013年1月至2019年6月于首都医科大学附属北京朝阳医院住院的TVT-O术后复发性SUI女性患者16例的临床资料,患者复发后均采用耻骨后无张力尿道中段悬吊术（TVT）治疗。分析患者的临床特点、手术疗效和安全性,并采用尿失禁问卷简表（ICI-Q-SF）、生活质量问卷（I-QOL）及尿动力学检查对术前与术后的情况进行比较。结果:16例患者年龄60.6±9.3岁,TVT-O术后2.5±1.3年SUI复发,复发后10例患者体质量指数（BMI）≥28.0 kg/m2,14例患者有尿道括约肌关闭功能受损。12例患者的既往吊带位于尿道中段,其中3例位于阴道肌层,无术中并发症。与术前相比,术后ICI-Q-SF评分显著降低,I-QOL评分则显著提高,差异均有统计学意义(（印）P（正）<0.05)。TVT术后主、客观治愈率均为93.8%（15/16）。随访8～46个月,所有患者均未出现SUI复发及中远期并发症,1例患者术后出现排尿困难,2例患者出现单侧会阴区疼痛,均予对症处理及时缓解。术后2个月复查各项尿动力学指标,与术前相比差异均无统计学意义(（印）P（正）>0.05)。结论:TVT-O术后SUI的复发可能与肥胖、吊带位置不正确和术式选择不当有关,二次行TVT术可有效和安全地治疗TVT-O术后复发性SUI。     

压力性尿失禁的注射治疗

压力性尿失禁治疗方法众多,一般分为手术和非手术两类,手术治疗常用于重度尿失禁患者,膀胱颈悬吊术或尿道中段悬吊术通过改变膀胱颈和尿道的角度或尿道中段悬吊,可以取得较好的治疗效果,但其创伤相对较大,术后可出现尿潴留等症状。对于轻中度患者可首先使用非手术治疗,非手术治疗包括盆底肌肉锻炼、电刺激、药物治疗、注射     

经阴道无张力尿道悬吊术治疗女性压力性尿失禁

目的观察经阴道无张力尿道悬吊术治疗女性压力性尿失禁临床疗效。方法采用经阴道无张力尿道悬吊术治疗21例女性压力性尿失禁患者。结果21例患者手术后尿失禁均得到控制,平均手术时间56min,平均出血78 ml,21例患者恢复正常排尿后测残余尿均<50 ml,经随访2-18个月无一例出现尿失禁现象。结论 TVT手术治疗女性压力性尿失禁具有可局麻下手术、手术创伤小、悬吊适度、疗效可靠持久、手术并发症发生率低等优点。适宜临床推广应用。     

压力性尿失禁4种不同手术方式治疗的临床效果分析

目的:分析应用尿道折叠术、耻骨后库柏韧带悬吊术(Burch)、阴道无张力尿道中段悬吊带术(TVT)以及经闭孔经阴道尿道中段悬吊带术(TVT-O)治疗压力性尿失禁(SUI)患者的临床效果.方法:回顾分析83例尿失禁合并子宫、阴道脱垂患者的临床资料,根据行不同手术治疗,将其分为行尿道折叠术组(32例)、Burch组(15例)、TVT组(22例)以及TVT-O组(14例),并对4组的术中、术后及并发症情况进行比较.结果:①TVT-O组患者手术时间最短77.6±4.0分钟,与其他3组比较,差异有统计学意义(P<0.05).TVT-O组和TVT组的患者在手术时间、留置尿管时间和住院天数上,与尿道折叠术组和Burch组比较,差异均有统计学意义(P<0.05).②TVT-O组吊带侵蚀1例,术后排尿困难1例;TVT组吊带侵蚀1例,术后排尿困难3例;Burch组排尿困难4例;尿道折叠术组外阴血肿2例,下肢静脉血栓形成1例,术后排尿困难7例.③TVT-O组手术治愈率最高100%,TVT-O组患者2年治愈率92.86%.结论:TVT-O操作简单、治愈率高,在保证较低手术并发症的同时,实现了2年随访期限内理想稳定的治疗效果.TVT-O术是目前治疗压力性尿失禁的比较理想的手术方法.     

延迟可吸收吊带与永久非吸收吊带治疗女性压力性尿失禁的疗效比较

目的探讨延迟可吸收吊带和永久非吸收吊带治疗女性压力性尿失禁的临床疗效及适宜的抗尿失禁手术材料。方法对2010年2月至2011年8月因压力性尿失禁在北京大学人民医院妇科进行手术治疗的51例患者的临床资料进行回顾性分析,其中研究组23例,采用延迟可吸收吊带;对照组28例,采用永久非吸收吊带。比较两组患者的手术情况、术后留置尿管时间及术后残余尿量,并采用尿失禁影响程度相关问卷（IIQ-7）和泌尿生殖道疾病相关问卷（UDI-6）评价手术疗效。结果两组患者的年龄、绝经时间、产次、病程、术前1h尿垫试验比较,差异均无统计学意义（P〉O．05）;两组患者的手术时间、术中出血量、术后留置尿管时间和术后残余尿量比较,差异均无统计学意义（P〉O．05）;研究组术后平均随访时间为（10．5±5．7）个月,对照组术后平均随访时间为（11．8±7．6）个月,两组患者主观治愈率分别为73．9％（17／23）和71．4％（20／28）,有效率分别为100．O％（23／23）和96．4％（27／28）,两组比较,差异均无统计学意义（P〉O．05）。两组均无吊带侵蚀等并发症。结论无论是延迟可吸收吊带还是永久非吸收吊带,治疗压力性尿失禁有相同的近期疗效,短期内未见吊带侵蚀,可能与本文随访时间短,手术例数少有关,需长期随诊进一步观察。     

阔筋膜悬吊术用于治疗女性压力性尿失禁

目的探讨自体阔筋膜吊带行尿道悬吊术治疗女性压力性尿失禁的疗效和安全性。方法对13例压力性尿失禁伴子宫脱垂及阴道前后壁膨出的患者,取自体大腿外侧阔筋膜条作为吊带,经下腹阴道联合切口,行尿道近端悬吊术,同时行阴式全子宫切除及阴道前后壁修补术,平均随访30个月。结果13例患者均获得治愈,无阴道出血、感染、排斥反应等并发症发生。5例患者在术后出现轻度、暂时性排尿困难,1个月内症状消失。结论自体阔筋膜吊带行尿道悬吊术是治疗女性压力性尿失禁的安全有效术式。     

Correction of cystocele and stress incontinence with anterior transobturator mesh

OBJECTIVE: To evaluate the effectiveness and safety of anterior transobturator mesh for treating cystocele with or without urinary stress incontinence. STUDY DESIGN: Eighty-five women with cystocele, with or without USI, underwent anterior transobturator vaginal mesh operation. All patients were examined after 4 months. Seventy-two of them were evaluated via questionnaire after 7 months with respect to complications, the effectiveness of the operation and its influence on their quality of life. Women with urinary stress incontinence in addition to cystocele (62.5%) underwent suburethral mesh placement with the anterior mesh-arms used like a transobturator sling. RESULTS: Recurrence of stage 1 cystoceles were seen in 9.6% of patients but no recurrence of symptomatic cystocele was observed. Mesh erosion of the central anterior vaginal wall appeared in 5.9%. Three revisions but no mesh explantation became necessary. Urinary stress incontinence was cured in 83.3%, while it improved in 9.3%. Urge incontinence was cured in 28.6% of patients and improved in 17.5%. De novo urge incontinence occurred four times and de novo urinary stress incontinence was found in three patients. Among sexually active women, 27% reported improved intercourse, while 24.3% reported a change for the worse. Quality of life improved in 81.9%, and 95.8% would undergo the procedure again. CONCLUSION: Anterior transobturator mesh is a safe method to treat cystocele with or without stress urinary incontinence and yields good initial results.     

超声尿动力学检查在女性压力性尿失禁手术前后的临床意义

目的 探讨女性压力性尿失禁手术前后的超声尿动力学的变化、临床意义。方法 对15例患有中重度的压力性尿失禁的女性患者，分别进行尿失禁的常规检查，超声尿动力学检查。应用不同的手术方法进行压力性尿失禁手术，如进行复合医用材料悬吊术，包括：In-fast Sling7例、TVT手术3例、Sparc 2例；还有耻骨上膀胱颈尿道悬吊术(Butch)3例。术后再次进行相应的检查。结果 经过各种不同的手术，压力性尿失禁的症状均得到缓解，有12例各项指标恢复或改善，3例检查指标无明显变化，但症状缓解。结论 超声尿动力学检查在女性压力性尿失禁的诊断、治疗方法的选择、术后的随访等方面有着重要的意义。     

阴道无张力尿道中段悬吊术治疗女性尿失禁的临床观察

目的　探讨阴道无张力尿道中段悬吊术 (tension freevaginaltape ,TVT)治疗女性尿失禁的临床效果。方法　回顾性分析自 2 0 0 1年 5月至 2 0 0 3年 2月 ,应用TVT手术治疗的 2 3例 (其中18例为压力性尿失禁 ,5例为混合性尿失禁 )女性尿失禁患者的临床资料。结果　 2 3例TVT手术中 ,除 1例因术中可疑有损伤而改为尿道折叠 (Kelly)术外 ,其余TVT手术均成功 ,手术成功率为96 % (2 2 / 2 3)。 2 0例 (91% )术后排尿功能恢复良好 ,2例 (9% )分别因膀胱不稳定 (运动型急迫性尿失禁 )及感染而发生排尿困难 ,经持续导尿、膀胱训练及药物治疗后 ,均恢复正常排尿功能。平均手术时间为 4 9min。术后两年随访所有患者 ,排尿功能均恢复正常。结论　TVT手术简单、微创、恢复快、效果好。     

Tension-free vaginal tape procedure: an effective minimally invasive operation for the treatment of recurrent stress urinary incontinence?

The aim of this study was to evaluate the results of tension-free vaginal tape (TVT) surgery in women with recurrent stress urinary incontinence (SUI). Fifty-one women with recurrent SUI were treated with TVT and followed prospectively for a minimum of 2 years according to a protocol. Twenty percent of the women had already undergone two previous continence procedures, whereas 80% had undergone only one. The mean follow-up period was 25.3 months. The objective cure rate was 89.6%, and the subjective cure rate 80.4%. No serious complications occurred. The majority of the patients were discharged in the afternoon of the operation day. No significant difference was observed between pre- and postoperative residual urine, maximal urethral closure pressure, and total and maximum voided urine volume values. However, the changes in urinary frequency, minimum voided volume, pad test results, and visual analog scale scores were highly significant. TVT appears to be a safe and suitable treatment for recurrent SUI.     

Evaluation of Urodynamic Findings Before and After Mid-Urethral Tape Sling Operation for Female Stress Urinary Incontinence

Study ObjectiveTo compare the urodynamic findings in female patients with stress urinary incontinence (SUI) before and after a mid-urethral tape sling operation.DesignMulti-channel urodynamic study (Canadian Task Force classification II-3).SettingDepartment of Urology, Huashan Hospital, Shanghai, China.PatientsWomen with SUI.InterventionsOne hundred ten patients underwent tension-free vaginal tape (TVT) surgery from September 2002 to December 2004 and 312 patients underwent tension-free vaginal tape–obturator (TVT-O) surgery from January 2005 to December 2011. The study was performed in all patients before surgery and at 3 and 6 months after surgery. Urine flow rate and residual urine volume were measured before and at 1, 3, and 6 month after surgery. Preoperative and postoperative data were compared to determine the urodynamic changes.Measurements and Main ResultsOf 422 patients, only 34 were lost to follow-up. The mean (SD) age of the remaining 388 patients was 57.6 (10.8) years, and parity was 1.87 (1.00). Compared with preoperative evaluation, there were significant changes in abdominal leak-point pressure and the urethral pressure profile including the maximal urethral pressure and the maximal urethral closure pressure at both 3 and 6 months postoperatively (p < .001). Insofar as urine flow rate and residual urine volume, statistical differences were observed at 1 month postoperatively but not at 3 and 6 months.ConclusionThese urodynamic findings suggest that patient storage and voiding functions are not substantially affected by the mid-urethral tape sling operation.