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。     

经阴道无张力尿道悬吊术治疗女性压力性尿失禁40例分析

目的：观察经阴道无张力尿道悬吊术(TVT)治疗女性压力性尿失禁的临床疗效。方法：2001年10月至2003年1月采用经阴道无张力尿道悬吊术治疗40例女性压力性尿失禁。结果：40例手术后尿失禁均得到控制，经随访2—26个月无一例出现尿失禁现象。平均手术时间54min，平均出血量80mL。40例患者恢复正常排尿后到残余尿均＜50mL。结论：TVT手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。     

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。     

压力性尿失禁的手术治疗

女性压力性尿失禁(stress urinary incontinence,SUI)的标准术式是阴道无张力尿道中段悬吊带术和以Bureh为代表的耻骨后膀胱颈悬吊术.使用合成材料医用材料的阴道无张力尿道中段悬吊带术因其更微创和易于操作,目前已成为全球一线的抗尿失禁的手术治疗方法.     

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。     

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     

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。     

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。     

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     

TVT-A与TVT-O治疗女性压力性尿失禁术后发生腹股沟疼痛情况分析

目的:比较使用改良式经闭孔经阴道无张力尿道中段悬吊术(tension-free vaginal tape-abbrevotm,TVT-A)与传统经闭孔无张力尿道中段悬吊术(tension-free vaginal tape-obturator,TVT-O)治疗女性压力性尿失禁术后发生腹股沟疼痛情况。方法:回顾性分析2014年1月至2016年4月87例采用TVT-A治疗压力性尿失禁及33例采用TVT-O治疗压力性尿失禁患者的临床资料,比较分析两组患者的术后效果及术后腹股沟疼痛的发生情况。结果:TVT-A和TVT-O两组手术均顺利完成,平均手术时间、术中出血量及治愈率差异无统计学意义(P0.05);术后腹股沟疼痛发生率TVT-A组明显小于TVT-O组,差异有统计学意义(P0.05);疼痛VAS评分TVT-A组小于TVT-O组,差异有统计学意义(P0.05)。结论:TVT-A治疗女性压力性尿失禁,安全有效,TVT-A较TVT-O术后腹股沟疼痛的发生率明显降低。     

Analysis of complications of the tension-free vaginal tape procedure for surgical treatment of female stress urinary incontinence

OBJECTIVE: The most common types of urinary incontinence in women are stress, urge and mixed incontinence. Stress urinary incontinence may be caused by an urethral hypermobility and internal sphincter deficiency (ISD). There are over 100 different surgical procedure for the treatment of female stress incontinence. Tension-free vaginal tape (TVT) is a new anti-incontinence surgical technique which was first described by Ulmsten in 1996. The aim of the study was to evaluate the complications of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. METHODS: The study group was consisted of 162 women, aged 32-84. All patients had a basic evaluation that included a history, frequency/volume chart, questionnaire of micturition (self-made), physical examination, stress test, Bonney test, urinalysis and bacterial culture of urine. Women with mixed urinary incontinence and who underwent surgical treatment of SUI in the past had been done urodynamic investigation. The operation was carried out under epidural, subarachnoid and general anesthesia. The TVT procedure was performed as described by Ulmsten. The follow-up was done after 1 day, 1 and 3 and 6 months since the operation. RESULTS: Among complications related to the procedure were 11 cases of cystotomy, 5 cases of urinary retention requiring four days catheterization, 3 cases of bleeding from the vagina, 14 cases of detrusor instability de novo. In 4 cases occurred postoperative obstinate pain. In 4 cases occurred recurrent urinary tract infection. None complication required invasive treatment. No evidence of defect healing or rejection of the tape was found. CONCLUSIONS: We conclude that the TVT procedure is safe method of the surgical treatment of urinary stress incontinence associated with a low complications.     

Tension-free vaginal tape (TVT) in women with low urethral closure pressure

OBJECTIVE(S): Aim of the study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) in women with stress urinary incontinence and low urethral closure pressure (LUCP). STUDY DESIGN: Thirty-seven patients with stress urinary incontinence and LUCP who were treated with the TVT procedure have been included in the study. Physical examination and urodynamic investigations were carried out to all women preoperatively and at 6, 12 and 26 months (average, range: 22-30 months), postoperatively. The mean age of the patients was 69 years (+/-13), while mean parity was 2.2 (range 0-3). RESULTS: TVT procedure was carried out in all patients with epidural anesthesia. Postoperative evaluation showed 27 patients (73%) to have been completely cured, four (9.25%) to have a considerable improvement, whereas six patients (16.2%) were classified as failures. Only a few complications occurred. CONCLUSION(S): Our study indicates that the TVT procedure is an effective and well-accepted minimal invasive surgery for treatment of urinary stress incontinence in women with LUCP. The cure rate of 73% could be considered satisfactory. Women with LUCP and 'fixed' urethra, are at significantly increased risk of failure of the procedure.     

Data from our recent trials with tension-free vaginal tape (TVT) procedure for surgical treatment of genuine urinary stress incontinence

There exist many surgical procedure for the treatment of urinary incontinence. Most of them require relatively extensive surgery and several days hospitalization. The advantage of tension-free vaginal tape procedure is a possibility to be performed on an ambulatory basis and under local anesthesia. OBJECTIVES: The aim of the study was to evaluate the results and morbidity of TVT procedure in genuine urinary stress incontinence. MATERIAL AND METHODS: The study group consists of 26 women, aged 39-69, suffering from genuine stress incontinence class I to III according to Stamey classification. The operation was carried out under epidural anesthesia. The procedure was performed as described by Ulmsten at al. The period of follow-up ranged from 3 to 20 month. RESULTS: The mean time of procedure was 26 minutes (range 18-43). The stay in hospital in 23 patient (88.46%) did not exceed 2 days. Three patients experienced urinary retention lasting four days requiring catheterization. No patients had bladder perforations or severe blood loss. No evidence of defect healing or rejection of the tape was found. Twenty four patients (92.31%) of patients were completely cured, 2 patients (7.69%) had considerably improved urinary continence. CONCLUSIONS: Our early study indicate that TVT procedure is effective and safe method of the surgical treatment of urinary stress incontinence in women.     

Pre-pubic TVT: an alternative to classic TVT in selected patients with urinary stress incontinence

OBJECTIVES: To evaluate in a prospective open study a pre-pubic route of TVT for surgical treatment of female stress incontinence. STUDY DESIGN: Consecutively, 74 patients were operated using a pre-pubic TVT tape application. All women were suffering subjectively and objectively from female stress urinary incontinence. The mean post-operative follow-up time was 5 months (range 2-10 months). The pre- and post-operative evaluations were performed according to a standard protocol. RESULTS: According to the protocol, 60 patients (81%) were cured of their stress incontinence symptoms. Another 10 patients (13%) were improved. Four patients (6%) were considered failures. There were no significant intra- or post-operative complications. CONCLUSION: The short-term results of pre-pubic TVT are consonant with those of classic TVT. The risks of intra-operative complications should be reduced by the pre-pubic route. If the long-term results of pre-pubic TVT are the same as those after classic TVT, then this surgical approach may be a tentative alternative in selected high-risk patients.     

A three-year postoperative evaluation of tension-free vaginal tape

The aim of this study was to evaluate the outcome of tension-free vaginal tape (TVT) 3 years after surgery. Fifty-one women (mean age 52.9) with a genuine stress incontinence underwent the TVT operation. In 10 patients, a prolapse repair was also done simultaneously. The majority of the patients were operated under local anesthesia. All patients were evaluated 3 years after the procedure using a protocol for objective and subjective assessment of the outcome including an evaluation of quality of life related to urinary incontinence. According to the protocol, 46 women (90%) were successfully cured, another 3 patients (6%) were improved, whereas 2 patients (4%) were classified as failures. Few complications occurred. We conclude that TVT is a simple and well-accepted minimal invasive surgery for treatment of female urinary stress incontinence. The outcome 3 years after the operation showed no signs of deterioration compared to the results shortly after surgery. The cure rate of 90% is comparable with the best results of other surgical treatments for female urinary incontinence. Copyright Copyright 1999 S. Karger AG, Basel     

Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence

OBJECTIVE: To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pad test. METHODS: In 6 departments of gynecology in Finland, including 4 university teaching hospitals and 2 central hospitals, 128 women with urodynamic stress incontinence were randomly allocated to 2 treatment groups. Seventy were treated with TVT and 51 by means of laparoscopic mesh colposuspension. There were 7 dropouts. Inclusion criteria were history of stress incontinence, positive stress test, and urodynamic conformation of stress incontinence. Exclusion criteria were age older than 70 years, previous incontinence surgery, more than 3 episodes of urinary tract infection within the last 2 years, coincident other gynecological surgery, body mass index more than 32 kg/m(2), urethral closure pressure less than 20 cm H(2)O, and residual volume more than 100 mL in preoperative urodynamic evaluation. Assessment took place before treatment and at 12 months postoperatively with the cough stress test, Urge Score, 48-hour pad test, King's College Health Questionnaire, Visual Analog Scale, and Urinary Incontinence Severity Score. RESULTS: When negative stress test was used as criteria for cure, 85.7% of women in the TVT group and 56.9% in the laparoscopic mesh colposuspension group were objectively cured. Subject satisfaction was significantly better after the TVT procedure than after laparoscopic mesh colposuspension. CONCLUSION: Treatment with TVT results in higher objective and subjective cure rates at 1 year than treatment by means of laparoscopic mesh colposuspension.     

TVT手术在女性压力性尿失禁中的应用

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 2 0 0 1年 5月以来 ,我院应用TVT手术治疗女性压力性尿失禁的临床疗效及并发症。结果 :17例尿失禁患者 (其中 13例压力性尿失禁 ,4例混合性尿失禁 )接受TVT手术 ,15例 ( 88 2 % )术后排尿功能恢复良好 ,2例 ( 11 8% )发生排尿困难 ,均经持续导尿、膀胱训练及药物治疗后恢复正常排尿功能。VTV手术的成功率为 10 0 %。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     

Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence

OBJECTIVES: Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. MATERIALS AND METHODS: About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). RESULTS: About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. DISCUSSION: Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. CONCLUSION: Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.