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1.
Fifty-four women with stress incontinence underwent a vaginal nylon sling procedure. Of these, 15 were diagnosed as having
type I, 27 as type II, and 12 as type III genuine stress incontinence. Follow-up averaged 25 months (range 6–42). The total
suture length prior to ligation, which supports the bladder neck with no tension, varied from 200 to 313 mm and demonstrated
weak correlation with body mass index (R2= 0.076, P = 0.043) and body weight (R2= 0.082, P = 0.036). The objective success rate was 89% (48 of 54 patients) 25 months later; the subjective rate was 93% (50 of 54 patients).
Kaplan–Meier analysis demonstrated that the cumulative continence rate was 85.6% at 42 months for those with type I, 88.4%
at 42 months for those with type II, and 91.7% at 40 months for those with type III incontinence (P>0.05). The main postoperative complication was retention or difficulty in urination. It was concluded that the total suture
length cannot be determined in relation to patient’s physical parameters, but rather on surgical experience, and that this
operation is recommended to those with not only intrinsic sphincter deficiency but also with urethral hypermobility, provided
surgery is executed with safe precautions. 相似文献
2.
Botulinum Toxin Urethral Sphincter Injection Resolves Urinary Retention after Pubovaginal Sling Operation 总被引:1,自引:0,他引:1
C. P. Smith M. O’Leary J. Erickson G. T. Somogyi M. B. Chancellor 《International urogynecology journal》2002,13(1):55-56
The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis
for anatomical urethral obstruction. Brubaker [1] recently reported on urethral sphincter abnormalities as a cause of postoperative
urinary retention following either Burch suspension or a pubovaginal sling procedure. We report a case of functional urethral
obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin
urethral sphincter injection. 相似文献
3.
C. P. Smith M. O’Leary J. Erickson G. T. Somogyi M. B. Chancellor 《International urogynecology journal》2002,13(3):185-186
The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis
for anatomical urethral obstruction. Brubaker [1] recently reported on urethral sphincter abnormalities as a cause of postoperative
urinary retention following either Burch suspension or pubovaginal sling procedure. We report a case of functional urethral
obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin
urethral sphincter injection. 相似文献
4.
C. Pajoncini E. Costantini F. Guercini M. Porena 《International urogynecology journal》2002,13(1):30-35
A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure
(VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral
mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off
value for VLPP were 60 cmH2O and for MUCP 30 cmH2O. MUCP ≤30 cmH2O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P= 0.02), more previous urogynecologic operations and the menopause (P= 0.004 and P= 0.000), and older age (P= 0.000). VLPP ≤60 cmH2O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P = 0.006) and poorer urethral mobility (P= 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different
pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence
of poor prognostic factors is increased. 相似文献
5.
G. M. Ghoniem A.-N. Elgamasy R. Elsergany D. S. Kapoor 《International urogynecology journal》2002,13(2):99-105
Intrinsic urethral sphincter deficiency (ISD) is a clinical entity that should be suspected in women with stress urinary
incontinence. If it is not diagnosed prior to surgery, it poses a significant risk factor for repair failure. We propose a
classification of ISD based on videofluorourodynamic (VFUD) and abdominal leak-point pressures. One hundred female patients
with stress urinary incontinence due to ISD were included in this study. History and physical examination were performed on
all patients. Each patient underwent a standard VFUD study with abdominal leak-point pressure (ALPP) measurement. ISD is classified
into subtypes according to VFUDS and ALPP. The findings were then correlated with the clinical presentation, etiology and
proposed management. Three types of ISD/SUI were identified. ISD-A, subtle/urodynamic, was present in 32 patients (32%). It
is most difficult to diagnose because radiologically the bladder neck is not open at rest, and it is only diagnosed by VFUD.
The abdominal leak-point pressure was less than 12 cmH2O. ISD-B was present in 45 patients (45%). This is characterized by a beak-shaped open bladder neck at rest. The abdominal
leak-point pressure was less than 90 cmH2O. ISD-C was present in 14 patients (14%). It is characterized by an open, fixed non-functioning urethra (pipe-stem) with
high position of the bladder neck. The abdominal leak-point pressure was less than 70 cmH2O. All the three subtypes had proximal urethral closure pressure (PCUP) less than 10 cmH2O. Based on these data, the treatment options may vary from one subtype to another. For ISD-A, initial treatment was medical,
with collagen injection being used for the failed cases. For ISD-B a modified pubovaginal sling was used, as it corrects the
ISD and the urethral hypermobility at the same time. For ISD-C, urethrolysis and takedown of the previous suspension was required
before using a sling. Collagen injections were used in selected cases. This classification identifies different subgroups
of ISD, which is important in the diagnosis and management of this condition. 相似文献
6.
The objective of this retrospective case control study was to determine whether our poor surgical outcomes were associated
with the material used to construct our pubovaginal slings. Autologous rectus fascia was used in 33 patients and cadaveric
fascia lata was used in 12 patients who underwent pubovaginal sling placement for intrinsic urethral sphincter deficiency
(ISD). Treatment was successful in 78.8% and 33.3% of patients who underwent rectus fascia and fascia lata allograft slings,
respectively (P=0.006). Based on regression analysis, the sling material was found to be strongly associated with surgical outcome after
controlling for all confounding variables (β coefficient = 1204.6, P<0.00005). We conclude that fascia lata allografts are a poor choice for pubovaginal slings. 相似文献
7.
A. J. Walter J. L. Buller G. Davis
the members of the Military Association of PelvicReconstructive Surgeons 《International urogynecology journal》2002,13(3):160-164
The aim of this study was to determine the commonly used techniques for sling surgery. A questionnaire was distributed to
the attendees at the 20th Annual Scientific Meeting of the American Urogynecologic Society. Techniques addressed included
the type and length of the graft material, the fixation point, and the methods of sling tensioning. Type of training and monthly
surgical volume was also determined. Sixty-five gynecologic and urologic surgeons responded to the survey, the majority of
whom were fellowship-trained urogynecologists (68%). The median monthly operative experience was 8 anti-incontinence procedures,
including 3.5 pubovaginal slings. There was wide inter-respondent variability in all techniques except fixation point. There
was also large intra-respondent variability in sling technique: 42% reported the use of differing graft materials, 19% noted
using differing graft lengths, and 19% employed variable tensioning methods. Type of training and operative experience did
not predict surgical technique(s) or consistency. Our conclusion was that there is wide variability in the techniques of sling
performance. 相似文献
8.
9.
C. F. Maher P. L. Dwyer M. P. Carey P. A. Moran 《International urogynecology journal》1999,10(6):384-389
The aim of this study was to compare Burch colposuspension with the pubovaginal sling in the management of low urethral pressure
urinary stress incontinence. Forty-five women with low urethral pressure stress incontinence were retrospectively reviewed:
21 underwent colposuspension and 24 a pubovaginal sling. The subjective success rate of the Burch colposuspension and the
pubovaginal sling was 90% and 71% (P= 0.12), respectively; the objective success rate was 67% and 50% (P= 0.26), respectively. The incidence of postoperative complications, including de novo detrusor instability and symptomatic
voiding dysfunction following the colposuspension, was 5% compared to 25% following the pubovaginal sling (P= 0.06). Colposuspension should be considered in the management of women undergoing surgical correction of low urethral pressure
stress incontinence. In a clinically similar group of women, the Burch colposuspension had a superior subjective and objective
success rate with a lower incidence of complications than did the pubovaginal sling. Although these differences failed to
reach statistical significance, colposuspension can be safely considered in the management of women with low urethral pressure
GSI. 相似文献
10.
Percutaneous bone anchor bladder neck suspension has been recommended as a less morbid alternative to traditional anti-incontinence
procedures. Specifically, it has reported to be associated with shorter duration of hospitalization, catheterization and urinary
retention, and equivalent short-term cure rates. Recently, there have been reports of pubic osteomyelitis associated with
bone anchor placement, and high incidences of recurrent incontinence. To improve the effectiveness of the procedure the placement
of a suburethral synthetic collagen-impregnated mesh without tension was recommended. A specific device is included with the
kit (Suture Spacer (Microvasive/Boston Scientific Corp., Natick, MA)) to prevent overcorrection of the urethrovesical junction.
We present a case of urethral erosion and complete urinary retention secondary to use of a percutaneous bone anchor sling
using a ProteGen mesh (Microvasive/Boston Scientific Corp., Natick, MA). Significant postoperative urethral overcorrection
was noted despite intraoperative use of the Suture Spacer. 相似文献
11.
The aim of this paper is to report vaginal erosion of cadaveric fascia lata used for abdominal sacrocolpopexy and suburethral
sling urethropexy. The charts of patients who underwent abdominal sacrocolpopexy or suburethral sling urethropexy between
March 1994 and February 1999 were reviewed for perioperative data. In 47 cases of abdominal sacrocolpopexy or suburethral
sling, 32 utilized cadaveric fascia lata, with 11 for sacrocolpopexy and 22 for suburethral sling. Vaginal erosion of cadaveric
fascia lata graft was noted in 5 (23%) following sling procedure and 3 (27%) following sacrocolpopexy, diagnosed a mean of
36.8 days (t 7.1, range 27–45) following surgery. These women were treated conservatively with estrogen vaginal cream, and
both vaginal and oral antibiotics. Four of the 8 (50%) underwent excision of the exposed graft and reapproximation of the
vaginal edges under local anesthesia, whereas the remainder responded to medical therapy alone. None of the patients experienced
recurrence of vaginal vault prolapse or urinary incontinence following graft erosion. Comparison of women with vaginal erosion
of cadaveric fascia lata to those without revealed an association with perioperative febrile morbidity (P = 0.04), but not with age, hormonal or insurance status, body mass index, history of diabetes mellitus or smoking, length
of surgery, estimated blood loss, change in hematocrit, or other perioperative complications. Vaginal erosion of cadaveric
fascia lata utilized for abdominal sacrocolpopexy and suburethral sling was noted in 25% of our patients and may have an infectious
etiology. Conservative treatment with antibiotics and estrogen is effective, but removal of exposed graft with vaginal closure
may be necessary. 相似文献
12.
Persistent urinary incontinence after failed surgical repair can be successfully treated with the artificial urinary sphincter.
The English literature was reviewed from 1985 to 1996. Eleven articles and abstracts addressing placement of the artificial
urinary sphincter in women were identified. Discussion includes two operative techniques. Success rates were in the range
of 91%–99%. Erosion rates were 7%–29%. The artificial urinary sphincter is an effective treatment for women failing other
procedures. Appropriate work-up and diagnosis for type III stress urinary incontinence is crucial. 相似文献
13.
Correlation of Urethral Closure Pressure, Leak-Point Pressure and Incontinence Severity Measures 总被引:4,自引:0,他引:4
C. W. Nager J. A. Schulz S. L. Stanton A. Monga 《International urogynecology journal》2001,12(6):395-400
The aim of this study was to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva
leak-point pressure (LPP), and which of these best correlates with subjective and objective incontinence severity measures.
Fifty-two women with previously diagnosed genuine stress incontinence (n= 46), or mixed incontinence with a minor and controlled urge component (n= 6), were assigned an incontinence status grade based on interview and diary review. These women then completed visually
observed standing LPPs at 250 ml bladder capacity, supine water perfusion MUCP determinations, pad tests and quality of life
questionnaires. The urodynamic and severity measures were compared with correlation analysis or analysis of variance. A modest
correlation exists between LPP and MUCP (r= 0.50–0.62, P<0.001). Both MUCP and LPP demonstrated significant decreases (P<0.01) with increasing severity of assigned incontinence grade. A very low and insignificant correlation existed for these
urodynamic parameters and pad loss or quality of life measures. MUCP and LPP correlate modestly with each other and both are
comparable in predicting incontinence severity. Either can be used as the urodynamic measure to assess intrinsic sphincter
deficiency. 相似文献
14.
The aim of this study was to determine whether an isolated low Valsalva leak-point pressure (VLPP) is predictive of intrinsic
sphincter deficiency (ISD) and can be an independent risk factor for retropubic urethropexy failure in patients with a normal
maximal urethral closure pressure (MUCP). Twenty-four women with urodynamically proven genuine stress incontinence with low
VLPP (<60 cmH2O) and normal MUCP (>20 cmH2O) were evaluated subjectively and objectively by complex urodynamic testing before and after undergoing a modified Burch
urethropexy. Success rates were then compared to historical success rates for subjects with ISD treated with retropubic urethropexy
using an exact one-sample test for binomial proportions. Patients were followed postoperatively for a mean of 11.1 months,
with a range of 5–16 months. Twenty-two of the 24 (91.7%) were continent on postoperative cystometry. This differs significantly
from the published success rates of 50% (P<0.001), if a low VLPP alone were predictive of ISD. Retropubic urethropexy was successful in the majority of our patients
with genuine stress incontinence with a low VLPP and normal MUCP. 相似文献
15.
Incontinence surgery is rarely performed prior to the completion of a woman’s childbearing. The literature is sparse in regard
to women with prior incontinence surgery. There are no reports of pregnancy complicated by a sling procedure. A 26-year-old
gravida 3, para 2-0-0-2 with prior surgical history of a Pereyra urethropexy followed by a Vesica suburethral sling, was referred
at 18 weeks’ gestation for assessment of the sling. Her antenatal course was complicated by pyelonephritis and intermittent
urethral obstruction requiring Foley catheter placement. She delivered by scheduled cesarean section at 37 weeks’ gestation.
Three months following delivery she presented with pyelonephritis and recurrence of her incontinence. Pregnancy complicated
by prior suburethral sling procedure may result in urinary outlet obstruction, pyelonephritis and disruption of the surgical
repair. 相似文献
16.
Our objective was to describe our experience with laparoscopic Burch colposuspension and to relate our results to traditional
open Burch procedures for the treatment of genuine stress incontinence. Retrospective case series were compared to historical
controls. Forty-six women found to have only genuine stress incontinence by history, examination and clinical urodynamics,
underwent a mesh and staple laparoscopic Burch procedure. Follow-up ranged from 3 to 50 months. Thirty-seven women were dry,
6 were improved and 3 showed no improvement. This compared to between 75% and 90% of women cured of stress incontinence by
the traditional open Burch procedure. We concluded that the results of a mesh and staple laparoscopic Burch procedure in a
carefully selected population of women with genuine stress incontinence appears comparable to that reported in the literature
for an open Burch procedure. 相似文献
17.
J. M. Choe 《International urogynecology journal》2001,12(2):122-128
The aim of the study was to assess the outcome of a 6-point fixation technique and weight-adjusted spacing nomogram for performing
sling surgery. Fifty women with stress incontinence underwent implantation of a Gore-tex patch sling. Sling tension was gauged
based on the patient’s body weight. Postoperative analysis was performed using cough stress tests, Q-tip tests, pelvic examinations
and patient satisfaction questionnaires. Urodynamics were performed for women with persistent incontinence. Mean follow-up
was 24 months (range 7–28). Mean age was 58 years (range 29–87). Stress incontinence was cured in 47/50 patients (94.0%).
De novo urge incontinence occurred in 1/23 (4.3%) patients. Mean time to suprapubic tube removal was 7 days (range 1–21).
No patients experienced urinary retention or urethral obstruction. Mean satisfaction score was 9/10 (range 7–10) and all patients
said they would undergo surgery again. The combination of a 6-point fixation technique and a weight-adjusted spacing nomogram
allows for a successful sling outcome without obstruction. 相似文献
18.
Pelvic Floor Dysfunction Management Practice Patterns: A Survey of Members of the International Urogynecological Association 总被引:2,自引:0,他引:2
G. W. Davila G. M. Ghoniem D. S. Kapoor O. Contreras-Ortiz 《International urogynecology journal》2002,13(5):319-325
The authors report results of a survey of the practice patterns of International Urogynecological Association (IUGA) members
in the management of urinary incontinence and pelvic organ prolapse. A questionnaire regarding current urogynecological clinical
practice was developed by the Research and Development Committee of IUGA and mailed to all members of IUGA. Age, specialty,
and geographic location factors were used for response comparisons. One hundred and fifty-two surveys (30%) were returned,
35% from North America, 51% from Europe/Australia/New Zealand, and 14% from elsewhere. The average age of respondents was
47.2 years (SD = 9.5), 89% were gynecologists and 11% were urologists. Overall, the procedures of choice for stress incontinence
(SUI) were tension-free vaginal tape (TVT; 48.8%) and Burch colposuspension (44%). There were significant geographic variations
noted. For SUI with low-pressure urethra/intrinsic sphincteric deficiency, TVT was used by 44.6% and suburethral sling by
32.3%. Various materials are used for suburethral slings, including autologous fascia (46.5%), Marlex mesh (27.8%) and cadaveric
fascia lata (11.6%). Bulking agent injection therapy is used for ISD by 75% of respondents. Traditional reconstructive procedures
are performed by the majority of respondents, including sacrospinous fixation (78%), abdominal sacrocolpopexy (77%), paravaginal
repair (65%) and vaginal enterocele repair (93%); 6.5% use defecography in evaluating rectoceles and 44% use the POP-Q. Seventy-two
per cent use urodynamic evaluation routinely in prolapse cases with no manifest SUI. Most IUGA members perform commonly accepted
procedures for surgical therapy of urinary incontinence and genital prolapse. IUGA members do not frequently use anorectal
physiology and fluoroscopic investigations to evaluate rectoceles prior to repair. 相似文献
19.
Epithelial inclusion cyst is an under recognized complication of the in-situ advancing vaginal wall sling. A 63-year-old
woman with stage I pelvic organ prolapse and mixed incontinence underwent in-situ sling placement in November 1997. In February
1998 she presented with a painful recurrent inflammatory anterior vaginal wall mass. The mass was cystic and drained spontaneously
four times over the period of conservative management. The patient underwent resection of a clinical and pathological vaginal
epithelial inclusion cyst in September 1998. At 6-month follow-up the patient remains continent and the cyst has not reformed.
The vaginal surgeon should be aware of the potential for epithelial inclusion cyst formation after in-situ sling placement,
and actively search for them at postoperative examination. 相似文献
20.
Injection Therapy for Stress Incontinence in Women 总被引:1,自引:0,他引:1
Periurethral bulking agents have been used to treat intrinsic sphincter deficiency for decades. Currently available agents
include polytetrafluoroethylene, glutaraldehyde cross-linked collagen, autologous fat and silicone microimplants. Polytetrafluoroethylene
has never been approved by the United States Food and Drug Administration for periurethral injection because of the risk of
particle migration. Early results have reported subjective cure rates of up to 95% with collagen injections. However, collagen
may cause allergic reactions and long-term results are still awaited. Periurethral fat injection has a reported success rate
ranging from 23% to 65%. It is simple and avoids the use of foreign materials, but the main disadvantage relates to the variability
of resorption and connective tissue replacement. Silicone microimplants need further study to evaluate their efficacy and
safety. The best material has not yet been defined. Long-term studies are still necessary to define the optimal injectable
agent. 相似文献