单切口可调节Ajust~(TM)吊带治疗女性压力性尿失禁的疗效评价

目的:评价使用单切口可调节AjustTM吊带治疗女性压力性尿失禁(SUI)的主观和客观效果。方法:2013年1月至2014年6月在我院因SUI行单切口可调节AjustTM吊带手术的患者共42例,术前、术后采用咳嗽压力实验、1h尿垫试验、尿失禁生活质量问卷(I-QOL)和性生活质量问卷(SLQQ)、改善整体印象的问卷(PGI-I)判断客观和主观治愈率。结果:42例手术均获得成功,无术中并发症,5例术后1天出现短暂性尿潴留,无排尿困难,无吊带侵蚀。患者客观治愈率97.6%(41/42),主观治愈率97.6%(41/42)。结论:单切口AjustTM吊带治疗女性压力性尿失禁操作简便,创伤小,并发症少,近期疗效良好。     

应用In-Fast吊带系统治疗女性压力性尿失禁的临床观察

压力性尿失禁(stress urinary incontinence，SUI)是妇科常见病，已逐渐引起妇产科医师的重视。手术是治疗SUI的主要方法之一。手术方式有很多种，因其远期疗效尚不理想，所以手术方法被不断地改进。现代外科手术的特点趋向于创伤小，并发症少以及远期疗效好。本院自2000年12月至2002年1月对10例中度以上压力性尿失禁患者，采用美国AMS公司生产的In—Fast吊带系统作经阴道膀胱颈下吊带耻骨固定术，收到良好效果。现将结果报道如下。     

经阴道吊带悬吊术(IVS)治疗女性压力性尿失禁

目的　观察IVS经阴道吊带悬吊术治疗女性压力性尿失禁临床疗效。方法　采用IVS经阴道吊带悬吊术治疗 2 6例女性压力性尿失禁患者。结果　 2 6例患者手术后尿失禁均得到控制 ,经随访 1～ 5个月无 1例出现尿失禁现象。平均手术时间 4 5min ,平均出血 5 6ml,2 6例患者恢复正常排尿后测残余尿均 <5 0ml。结论　IVS经阴道吊带悬吊术治疗女性压力性尿失禁具有手术创伤小、在局麻下手术、吊带悬吊效果可靠、作用持久、手术悬吊适度、手术并发症发生率低等优点。适宜临床推广应用     

女性压力性尿失禁药物治疗的临床疗效分析

目的探讨α受体激动剂与雌激素联合使用,治疗女性压力性尿失禁的临床疗效。方法对Ⅰ～Ⅲ度已绝经的女性压力性尿失禁的患者40例,采用盐酸米多君(α受体激动剂)2.5mg/次,3次/d,利维爱(组织选择性雌激素活性调节剂)1.25mg/d,疗程8周,进行治疗前后对比研究。结果40例患者药物治疗后平均尿失禁量减少13.0g(P<0.01);尿失禁临床程度明显改善,有效率为87.5%,治疗前后比较差异有显著意义(P<0.01);治疗后血E2水平明显升高(P<0.01),用药期间无不良事件发生。结论α受体激素剂和雌激素联合应用,对绝经后Ⅰ、Ⅱ度女性压力性尿失禁患者疗效满意,使用安全,而且丰富了压力性尿失禁的治疗手段。     

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。     

自制蝶型网片吊带治疗老年女性压力性尿失禁的近期疗效观察

目的:探索蝶型网片治疗老年女性压力性尿失禁(SUI)的可行性及疗效。方法:用自行设计的蝶型网片,改进固定方法和部位,对65岁以上老年女性压力性尿失禁患者21例进行治疗。结果:21例手术后尿失禁均得到控制或减轻,经随访3～12月无一例出现尿失禁复发和加重现象。结论:蝶型网片治疗老年女性SUI疗效确切,具有费用低、手术创伤小、不损伤膀胱等优点。     

女性压力性尿失禁手术治疗进展

女性压力性尿失禁（SUI）手术治愈率高，患者术后生活质量提高明显，是值得花费的治疗。其目的即通过恢复盆底正常的解剖结构，进而达到自主控尿的功能，防止尿失禁的发生。治疗女性SUI手术有多种，不同手术有自身优缺点．近来SUI手术逐渐向微创型发展并取得较好疗效。根据各种术式进展及其疗效对比作一综述。     

前瞻性随机对照研究比较阴道无张力吊带和经闭孔尿道下吊带两种手术治疗压力性尿失禁的效果

压力性尿失禁（SUI）是困扰中老年女性的一种常见病理情况，其手术方式繁多，却极少有资料客观前瞻性评价这些术式。近年手术治疗SUI的基本原理发生了改变。虽然无张力性尿道吊带（TVT）有较高的手术成功率．但因该术可发生肠道和大血管损伤。膀胱和尿道穿孔．术后排空障碍如一过性尿潴留等，对手术安全性提出质疑。本研究采用前瞻性随机对照法评价TVT和经闭孔的尿道吊带（TOT）两种手术治疗SUI的临床效果和术后膀胱出口的阻力。     

Grouts-Blaivas评分法评价无张力阴道吊带术治疗压力性尿失禁的临床价值

目的:观察无张力阴道吊带术(TVT)治疗女性压力性尿失禁的临床疗效,并探讨Grouts-Blaivas评分法评价该法治疗尿失禁效果的临床价值。方法:对25例中、重度女性压力性尿失禁患者采用TVT治疗,手术后采用Grouts-Blaivas评分法评价尿失禁情况,并定期随访。结果:25例患者TVT均取得满意疗效。术后随访3~21个月,按Grouts-Blaivas评分法,尿失禁治愈率为92%(23/25),1例改善良好,1例改善中等,无手术失败及严重并发症发生。结论:TVT治疗女性压力性尿失禁有效、安全,且疗效持久。Grouts-Blaivas评分法是一种较为全面的评价尿失禁疗效的方法。     

TVT和TVT-O治疗女性压力性尿失禁的临床结果分析

经耻骨后无张力尿道悬吊带术(retropubic tension-free vaginal tape,TVT)和经闭孔无张力尿道悬吊带术(transobturator vaginal tape inside-out,TVT-O)是近年开展的治疗女性压力性尿失禁(stress urinary incontinence,SUI)的微创术式,我院自2002年起将两种术式用于临床,现总结分析如下.     

经耻骨后与经闭孔无张力尿道悬吊术治疗女性压力性尿失禁并发症分析

目的比较经耻骨后无张力尿道悬吊术（TVT）和经闭孔无张力尿道悬吊术（TVT—O）治疗女性压力性尿失禁的手术并发症。方法回顾性分析我院2002年9月-2007年6月应用TVT和TVT—O治疗女性压力性尿失禁患者167例（TVT术74例,TVT-O术93例）的临床资料。结果术中膀胱穿孔：TVT组发生率为9．46％,TVT—O组为1．08％（P〈0．05）;术中出血〉100ml：TVT组发生率为16．22％,TVT—O组6．45％（P〈0．05）,其他术中、术后并发症发生率两种手术方法比较,差异无显著性（P〉0．05）。结论与TVT比较,TVT-O手术并发症的发生率低,且手术操作简便、手术时间短,是一种较理想的治疗女性压力性尿失禁的手术方法。     

A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence

Objective

To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI).

Methods

The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n = 498) or TOT (n = 272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed.

Results

Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P < 0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P < 0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P = 0.007; urinary retention 10.7% versus 26.9%, P < 0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P = 0.574; subjective cure rate, 76.8% versus 81.7%, P = 0.416).

Conclusion

In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.     

Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure

AIM: To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). METHODS: Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. RESULTS: The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). CONCLUSION: The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.     

Simple sling resection and a second, intermediate polypropylene mesh for treatment of vaginal tape protrusion concurrent with recurrent urinary stress incontinence after TVT procedure

The tension-free vaginal tape (TVT) procedure is a simple, effective and minimally invasive method for the surgical treatment of urodynamic stress incontinence (USI). Yet, complications such as mesh protrusion and recurrent urinary leakages after TVT have been reported. A case of recurrent USI complicated with vaginal mesh protrusion following a TVT procedure was referred. Video-urodynamics and introital ultrasonography confirmed that the recurrence of USI was secondary to mal-position of the protruded TVT. A simple salvaging procedure was carried out. The mal-positioned distal protruded TVT was resected and a second intermediate piece of polypropylene (Prolene) mesh was replaced at mid-urethra. The operation time was short and blood loss was minimal. The patient was objectively continent at 6 months follow-up with no defect of healing. Considering the cost-effectiveness and invasiveness of the surgeries, the method of inserting an intermediate mesh is clinically useful.     

Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence.

OBJECTIVE: To compare the cure rate and confirm the clinical efficacy of the 3 most frequently performed surgical procedures for stress urinary incontinence (SUI). METHODS: Between January 2001 and May 2003, 92 women with SUI were randomly assigned to undergo the Burch colposuspension (n=33), pubovaginal sling (n=28), or tension-free vaginal tape (n=31) at the Department of Obstetrics and Gynecology, Yonsei Medical Center, Seoul, Korea. Patient characteristics, urodynamic study results, cure rates at 3, 6, and 12 months, and complication rates were compared using the chi2 test. RESULTS: There were no statistically significant differences in the cure rates initially, but after 12 months the cure rate of the pubovaginal sling procedure was found to be significantly higher than those of the tension-free vaginal tape or Burch colposuspension procedures. CONCLUSION: The cure rate of the pubovaginal sling procedure was significantly higher after 1 year, but no difference in efficacy was observed between the 2 other procedures. A randomized prospective study of a larger population should be conducted.     

Comparing vaginal tape and transobturator tape for the treatment of mild and moderate stress incontinence.

OBJECTIVE: To compare the efficacy and safety of the tension-free vaginal tape (TVT) and transobturator suburethral tape (TVT-O) procedures for the treatment of mild and moderate stress urinary incontinence (SUI). METHODS: A total of 56 women were randomly selected to undergo the TVT-O or the TVT procedure. In some patients, vaginal repair or vaginal hysterectomy was done simultaneously for associated indications. RESULTS: Mean blood loss and hospital stay duration were the same for the 2 groups, but mean +/- SD operative time was significantly shorter in the TVT-O than in the TVT group (16+/-4 min vs 27+/-6 min; P<0.001). On the second day following surgery a residual urine volume less than 100 mL was noted in 86% and 89% of the patients in the TVT-O and TVT groups, respectively; cure was achieved in 92.9% and 92.6% of the patients. No serious complications occurred in either group. Outcome was subjectively assessed, with the patients followed-up for a mean of 27.6 months. CONCLUSION: No significant differences in rates of cure, postoperative urine retention, or operative complications were found following the TVT-O or the TVT procedure.     

Transfascial vaginal tape (TFT): a simple,safe and cost-effective procedure for stress urinary incontinence. A preliminary study

Objective To analyse prospectively the effectiveness of a new simple, minimally invasive, and cost-effective technique for the treatment of female urinary stress incontinence: the transfascial vaginal tape (TFT). Materials and methods In a prospective study, we enrolled 45 women undergoing TFT with or without hysterectomy and/or another pelvic reconstructive procedure between 1st December 2003 and 31st December. TFT consists of a tension-free urethrosuspension using a sling located at the mid-urethral level and placed laterally in the endopelvic fascia previously perforated. Follow-up evaluations were established at 3 and 6 months and at 1 year after the operation. During each follow-up, women underwent cough stress test and they answered to the “Incontinence quality of life questionnaire” (I-QOL), to the Patient Global Impression of Severity (PGI-S) and of Improvement (PGI-I) questions. Results Thirty-nine patients (88.9%) had a follow-up examination 1 year after surgery. Of these, 30 (76.9%) were defined cured, 6 (15.4%) improved and 3 (7.7%) failed. Conclusions TFT procedure can be considered a simple, safe and cost-effective procedure for the treatment of stress urinary incontinence and can be an alternative to tension-free vaginal tape or transobturator route for sub-urethral tape procedures.     

Outcome of midurethral tape continence surgery in patients with and without urodynamically confirmed stress incontinence

Objective

To compare the outcomes of midurethral tape continence surgery in patients with urodynamically confirmed stress incontinence (USI) and patients with symptoms of stress urinary incontinence but normal urodynamic studies (NUDS) and a positive 1-h pad test.

Study design

Analysis of data collected prospectively from 356 women who underwent tension-free vaginal tape (TVT) surgery from June 1998 to September 2009. There were 25 women with NUDS but a positive pad test. Outcome measures in these 25 women were compared with 65 women with urodynamically confirmed stress incontinence. These 65 women were chosen as suitable controls from the group of 331 potential controls. All the women underwent TVT surgery under local or spinal anaesthesia.

Results

The outcome measures were: (1) absence of stress urinary incontinence symptoms, (2) new occurrence of lower urinary tract irritative symptoms (LUTS), (3) persistent voiding dysfunction (VD), and (4) recurrent urinary tract infections (UTIs). Following TVT, stress incontinence was absent in 100% and 97% of patients in the NUDS and USI groups respectively. The occurrence of LUTS was 4% and 4.6% in the NUDS and USI groups, while VD was found in 4% and 4.6% and recurrent UTIs in 8% and 6.1% of the groups respectively.

Conclusion

There were no significant differences in outcomes following TVT in patients with and without urodynamically confirmed stress urinary incontinence.