单纯性SUI的手术方法及其评价

压力性尿失禁(stress urinary incontinence，SUI)是常见的老年性疾病，同时常合并生殖器官的膨出和脱垂。SUI占整个尿失禁发病率的50％以上，其实际发病率比临床统计数值更高，给老年女性带来痛苦并造成严重的社会经济负担。随着泌尿妇科学(urcgyneeology)的发展，手术已成为治疗压力性尿失禁的主要方法。本文就女性SUI的手术治疗及其评价作一综述。     

聚丙烯酰胺水凝胶注射治疗女性压力性尿失禁疗效分析

目的探讨聚丙烯酰胺水凝胶治疗压力性尿失禁(SUI)的疗效。方法回顾性分析2005年10月至2010年8月德国开姆尼茨红十字中心医院应用聚丙烯酰胺水凝胶经尿道注射治疗压力性尿失禁患者450例,追踪381例术后的主观效果和客观效果。结果术后患者的主观评价结果显示SUI的治愈率和好转率之和为76.4%,客观评价结果显示SUI的治愈率和好转率之和为83.2%,无严重并发症发生。结论经尿道注射聚丙烯酰胺水凝胶治疗压力性尿失禁具有安全、简便、疗效确切、并发症少、患者可接受性高等优点,有望成为女性SUI的重要治疗方法,但仍需长期随访。     

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.     

会阴部超声检查在压力性尿失禁手术前后的应用价值

尿失禁是中老年妇女的常见病，压力性尿失禁（stress urinary incontinence，SUI）是女性尿失禁中最常见的类型。手术是治疗SUI最有效的手段。超声可了解SUI手术前后的病理解剖学信息，为手术提供依据，评价手术疗效。本文对26例中、重度SUI患者采用两种不同的手术方法进行矫正，并应用超声进行手术前后检查，     

盆底肌肉锻炼(PFMT)在女性压力性尿失禁中的应用进展

压力性尿失禁(SUI)是我国成年女性的主要尿失禁(UI)亚型,患病率为18.9%。压力性尿失禁(SUI)和压力性为主的混合性尿失禁(MUI)的治疗中,盆底肌肉锻炼(PFMT)一般推荐为首选。PFMT是目前最常用的产后UI治疗措施。PFMT对女性SUI的预防和治疗作用已被证实,采用规范的、强化的、监督式的PFMT是有效的。     

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。     

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。     

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。     

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。     

电刺激及生物反馈治疗女性压力性尿失禁

目的:观察通过生物反馈电刺激治疗女性压力性尿失禁,探讨其疗效。方法:选择75例Ⅰ～Ⅱ度女性压力性尿失禁的患者,将患者随机分为生物反馈电刺激治疗组42例和KEGEL训练治疗组33例,治疗后观察评定尿失禁改善情况,对照分析各治疗组的疗效。结论:生物反馈电刺激治疗Ⅰ～Ⅱ度女性压力性尿失禁是一种有效的、治愈率较高的保守治疗方法。     

Sling operation for urinary incontinence

105 women with urinary stress incontinence were treated over an 8-year period. The operations carried out were: 44 Zoedler slings using mersilene and 61 slings using lyodura. Follow-up lasting from 3 to 11 years showed complete failure in 17 patients (16%). The plastic slings of the Zoedler type led to an increased risk of complications such as retropubic infections, rejection of the mersilene, and chronic urinary retention. The lyodura sling was considered good prosthetic material. Our experience shows that a sling operation, as a primary method, may be selected for patients with stress urinary incontinence and a large degree of descent of the anterior vaginal wall and/or uterus.     

经阴道尿道中段补片悬吊术治疗压力性尿失禁的临床观察

目的评价经阴道尿道中段补片悬吊术治疗压力性尿失禁(SUI)的近期疗效。方法2003年7月—2004年2月,对确诊为SUI的82例患者,在局部麻醉下行经阴道尿道中段补片悬吊术,并于治疗后1、3、6个月进行随访。根据患者的主诉,以能自控排尿、无尿失禁症状为治愈;尿失禁次数及漏尿情况较术前明显减少为改善;尿失禁症状未改善或加重为无效,观察疗效及并发症。结果82例患者平均手术时间(27±9)min,平均出血量(21±6)ml。72例术后2h去除导尿管后能自行排尿,24h后测量残余尿<100ml,术后48h出院;10例术后2h去除导尿管后出现短暂尿潴留,再次留置导尿管48h后排尿正常,再观察24h后出院。82例患者出院时78例为治愈,4例(合并脑出血后遗症患者)为改善。76例随访1~6个月,其中74例为治愈,2例为改善。无发生尿潴留、尿路感染及膀胱功能障碍者。结论经阴道尿道中段补片悬吊术治疗SUI方法简单、近期效果确切。     

Effects of pubovaginal sling procedure on patients with urethral hypermobility and intrinsic sphincteric deficiency: would they do it again?

OBJECTIVE: This study was undertaken to assess the cure rate of stress urinary incontinence, long-term effects on other lower urinary tract symptoms, and quality of life in a cohort of patients who underwent pubovaginal sling procedures for treatment of incontinence related to intrinsic sphincteric deficiency and urethral hypermobility. STUDY DESIGN: This was a retrospective analysis of 57 patients with 90% follow-up who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence related to urethral hypermobility and intrinsic sphincteric deficiency. Objective postoperative urodynamic evaluation was performed in 34 (60%) of the cases. Telephone interviews to assess quality-of-life parameters were performed in all cases. RESULTS: The mean follow-up period was 42 months and the median follow-up period was 34 months, with a range of 0.5 to 134 months. The age at the time of the sling procedure ranged from 18 to 84 years, with a median parity of 3.0 (range, 0-6). Preoperative body mass index ranged from 19.5 to 39.1 kg/m(2). Five percent of patients had detrusor instability before the operation. Forty-one percent (41%) of the patients who underwent postoperative urodynamic evaluation had voiding dysfunction. The postoperative objective cure rate for stress urinary incontinence was 97%. Of all patients 88% indicated that the sling had improved the quality of life, 84% indicated that the sling relieved the incontinence in the long-term, and 82% would choose to undergo the procedure again. CONCLUSION: Construction of a pubovaginal sling is an effective technique for relief of severe stress urinary incontinence. Voiding dysfunction is a common side effect. Despite this problem, a significant number of patients would elect to undergo the procedure again.     

The fascia lata sling procedure for treating recurrent genuine stress incontinence of urine

The fascia lata sling procedure has been used over the past 22 years in our unit for treating recurrent urinary stress incontinence when irreparably poor local support tissues were suspected. Sixty-nine patients had undergone one previous operation to correct urinary stress incontinence. One hundred one patients had two or more previous operations. The cure rate for the condition of genuine stress incontinence has been 100% in the last 148 cases and 98.2% overall. However, the cure rate for the symptom of urinary stress incontinence was 92.4%. There were only three sling failures in the entire series, occurring in the first 22 cases. Ten other patients had urinary incontinence with stress because of motor urge incontinence. The most troublesome postoperative problem has been delayed voiding.     

Experience with Silastic Slings for Female Urinary Incontinence

Between September 1, 1985 and December 31, 1987, 54 patients with stress urinary incontinence were treated with a reinforced silastic sling using an abdominovaginal approach; 42 patients were cured, two improved and nine were the same or worse. Five patients who are continent required periodic intermittent self-catheterization. Eight patients developed detrusor instability postoperatively. One patient had to have the sling removed due to a persistent sinus. Fifteen patients had to have the sling adjusted.     

Sling operations in the treatment of stress urinary incontinence: how to adjust sling tension

AIM: To find an objective method of adjusting sling tension in order to avoid postoperative urinary obstruction. METHODS: Thirty-five female patients with type II/III and type III stress urinary incontinence were treated using a sling procedure. Pubovaginal fascial slings were implanted in 20 patients and polytetrafluoroethylene patch slings with nylon sutures were implanted in 15 patients. During the procedures the urinary bladder was partially full and the patients, who were under spinal or epidural anesthesia, were asked to cough and strain. The proper tension that effectively prevents urine leakage was selected and the corresponding suture length was marked. An objective new method to adjust sling tension was used. As part of this method, the abdominal bulge index is added to the suture length before tying. RESULTS: Short-term follow-up of 6-12 months showed that 33 of 35 patients reported no leakage of urine (94%). Two patients had unsatisfactory urge incontinence. We did not encounter postoperative urinary retention in any patient. No significant post-voiding residual urine was reported. None of our patients in this series have complained of difficulties during micturition or the need to strain during voiding. CONCLUSION: Proper adjustment of sling tension using the abdominal bulge index has eliminated postoperative urinary retention and obstructed urine flow, including any appreciable amount of post-voiding residual urine. This method has been found to be both objective and reproducible.     

Sling distress: a subanalysis of the IVS tapes from the SUSPEND trial

AIM: To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. MATERIALS AND METHODS: The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. RESULTS: A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. DISCUSSION/CONCLUSION: The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients.     

The fascia lata suburethral sling for treating recurrent urinary stress incontinence

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the fascia lata suburethral sling procedure in the treatment of recurrent genuine urinary stress incontinence. STUDY DESIGN: This study was a retrospective analysis of 60 patients who had a suburethral fascia lata sling placement between January 1992 and December 1995. Follow-up ranged from 6 months to 3.5 years. The database was obtained by a retrospective chart review, a written questionnaire, and telephone interview. RESULTS: Between January 1992 and December 1995, 72 patients who had at least one previous incontinence procedure were assessed by urodynamic testing and cystourethroscopic examination before undergoing a fascia lata sling placement. Of this population, 60 were available for follow-up. Of this 60, 54, or 90%, had complete cure or marked improvement in the urinary incontinence. There were six failures, two of which had no bladder neck mobility and two of which had detrusor instability and were unable to take medication because of medical contraindications. In addition, two slings were sacrificed because of postoperative complications. The most common postoperative complication was urinary retention, which resulted in eight, or 13.4%, of slings needing to be released. CONCLUSION: Our data support the use of the suburethral fascia lata sling as an effective method for the treatment of recurrent genuine urinary stress incontinence, with urinary retention being the most common postoperative complication.(Am J Obstet Gynecol 1997;177:6)     

The Marlex sling operation for the treatment of recurrent stress urinary incontinence: a 16-year review

Between 1968 and 1983, 281 patients with recurrent stress urinary incontinence and nine patients with primary stress urinary incontinence were treated with a two-team (suprapubic vaginal) Marlex urethral sling operation. Selection was based on the patient's history and the clinical demonstration of an anatomic defect in the closure mechanism of the urethra. The operative technique as described in 1970 remains unchanged. The bladder neck is released from the scar and replaced in a midretropubic position on a hammock of Marlex mesh attached to Cooper's ligaments. Patients with a sloughed urethra had a sling operation in conjunction with the reconstruction of a neourethra. The overall success rate based on a minimum 5-year follow-up of 208 patients was 77.4%. There was a high failure rate in the sloughed urethra group. Significant overall complications include bladder neck obstruction and chronic cystitis.