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1.
Terry White Amie Kawasaki Reneita V. Ross Rony A. Adam Thinh H. Duong 《International urogynecology journal》2009,20(9):1109-1112
Introduction and hypothesis The objective of this study was to measure the correlation of maximum urethral closure pressure (MUCP) with Valsalva leak
point pressure (VLPP) in women with urodynamic stress incontinence using air-charged urodynamic catheters.
Methods Records of all women who underwent urodynamic testing for urinary incontinence using air-charged catheters over a 3-year period
were reviewed. Data included scores on the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7).
Results One hundred ninety-three women met the criteria for urodynamic stress incontinence. There was a modest correlation of MUCP
with VLPP at 200 mL (r = 0.46, p < 0.001) and a low correlation of MUCP with VLPP at maximum capacity (r = 0.35, p < 0.001). There was no correlation of UDI-6 or IIQ-7 scores with MUCP or VLPP.
Conclusions The low to modest correlation of VLPP with MUCP with air-charged catheters is similar to what has been reported with water-filled
and microtransducer catheters. 相似文献
2.
Rebecca Rogers Gloria Bachmann Zhanna Jumadilova Franklin Sun Jon D. Morrow Zhonghong Guan Tamara Bavendam 《International urogynecology journal》2008,19(11):1551-1557
We evaluated overactive bladder (OAB) symptoms and sexual and emotional health in sexually active women with OAB/urgency urinary
incontinence (UUI) treated with tolterodine extended release (ER). Sexually active women with OAB symptoms were randomized
to placebo or tolterodine ER. Five-day bladder diaries, Sexual Quality of Life Questionnaire—Female (SQOL-F), Pelvic Organ
Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), and Hospital Anxiety and Depression Scale (HAD) were completed
at baseline and week 12. Tolterodine ER (n = 201; mean ± SD age, 49 ± 12 years) reduced UUI episodes (P = 0.0029), total (P = 0.0006) and OAB (P < 0.0001) micturitions, and pad use per 24 h (P = 0.0024), and was associated with improvements in SQOL-F (P = 0.004), PISQ total (P = 0.009), and HAD Anxiety (P = 0.03) scores versus placebo (n = 210; mean ± SD age, 47 ± 12 years). OAB symptoms improved with tolterodine ER as did the scores of sexual health and anxiety
measures in sexually active women with OAB. 相似文献
3.
Stavros Athanasiou Charlotte Chaliha G. Alessandro Digesu Myrtia Sotiropoulou Nicolaos Georgoulias Vik Khullar Aris Antsaklis 《International urogynecology journal》2007,18(7):763-767
The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology
in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King’s Health
Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry,
measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations
were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine,
the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H2O; p = 0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p < 0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H2O; p = 0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase
in URP (50.3 to 59.1 cm H2O; p = 0.001), sphincter thickness (1.7 to 2.1 mm; p < 0.001), and MUCP (50.2 to 58.1 cm H2O; p = 0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound
morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required
to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in
an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness. 相似文献
4.
Hendrik Cammu Elke Van Den Abbeele Hellen Nagel Patrick Haentjens 《International urogynecology journal》2009,20(7):775-780
Introduction A study was performed to determine which patients’ characteristics before tension-free vaginal tape (TVT) for stress incontinence
are predictive of a failed outcome.
Methods A prospective cohort of 305 women with urinary stress incontinence underwent a TVT procedure in a teaching hospital. TVT was
considered successful when the patient was fully satisfied and no leakage was seen at the standardized stress test. Logistic
regression analysis examined the relationship between outcome and 32 pre-, intra-, and postoperative patient characteristics.
All operations were done by trainees under supervision and assistance.
Results and conclusions Eighty one percent was successfully treated. Independent predictors of TVT failure were previous surgery for incontinence
(P = 0.006), >2 pads/diapers per day before treatment (P = 0.012), chronic use of psychotropic medication (P = 0.012), and a more advanced age of the patient (P = 0.005). Postoperative urgency was independently related to preoperative urgency (P < 0.001). Independent predictors of postoperative dissatisfaction were urgency symptoms (P < 0.001) and the need for a re-intervention (P < 0.001). 相似文献
5.
Joseph M. Novi Catherine S. Bradley Najjia N. Mahmoud Mark A. Morgan Lily A. Arya 《International urogynecology journal》2007,18(10):1163-1169
The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele
repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated
questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative
sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage 2 or greater. Fifty women
underwent rectocele repair utilizing porcine dermis graft (group 1) and 50 women underwent a site-specific repair of the rectovaginal
fascia (group 2). The same questionnaire was administered to all subjects 6 months after surgery. The two groups were similar
in age, race, parity, prior hysterectomy, and postmenopausal hormone use. Preoperative sexual function scores were similar
in the two groups (group 1 81.4 ± 7.3 and group 2: 83.6 ± 8.2, p = 1.0). Six months after surgery, PISQ scores in group 1 significantly increased (score increase 19.9 ± 2.2, p = 0.01). The mean increase in PISQ scores for group 2 was 6.9 ± 3.1 (p = 0.08). When compared with group 2, subjects undergoing rectocele repair with porcine dermis graft scored significantly
higher on the PISQ 6 months after surgery (group 1 101.3 ± 6.4 and group 2 89.7 ± 7.1, p = 0.01). We conclude that rectocele repair using porcine dermis graft is associated with improved sexual functioning when
compared with site-specific rectovaginal fascia repair. 相似文献
6.
Sheng-Mou Hsiao Bor-Ching Sheu Ho-Hsiung Lin 《International urogynecology journal》2008,19(5):627-632
The objective of this study was to sequentially compare the urodynamic findings of patients with urodynamic stress incontinence
before and after transobturator tape procedure. Between May 2004 and December 2005, 26 of 34 consecutive patients with urodynamic
stress incontinence who underwent transobturator tape procedure were enrolled. The sequential urodynamic findings of each
case were compared and analyzed. Based on pad test, the cure and improvement rates were 69.2 and 30.8%, respectively. A significant
increase in pressure transmission ratio at maximal urethral pressure at 1 year postoperatively (p = 0.005) was observed after surgery. The improvement group (n = 8) had significantly lower preoperative maximal urethral closure pressure (45.4 vs 68.2 mmHg, p = 0.036) than did the cure group (n = 18). The postoperatively increased pressure transmission ratio at maximal urethral pressure appears to contribute to its
cure for urodynamic stress incontinence. 相似文献
7.
Holly?E.?Richter Jennifer?M.?Creasman Deborah?L.?Myers Thomas?L.?Wheeler Kathryn?L.?Burgio Leslee?L.?Subak for the Program to Reduce Incontinence by Diet Exercise Research Group 《International urogynecology journal》2008,19(12):1653-1658
The purpose of this study was to describe urodynamic characteristics of overweight or obese women with urinary incontinence
and explore the relationship between urodynamic parameters, body mass index (BMI), and abdominal circumference (AC). One hundred
ten women underwent a standardized cough stress test and urodynamic study. Eighty-six percent of women had urodynamic stress
incontinence and 15% detrusor overactivity. Intra-abdominal pressure (Pabd) at maximum cystometric capacity (MCC) increased
0.4 cm H2O per kg/m2 unit of BMI (95% confidence interval [CI] = 0.0,0.7, p = 0.04) and 0.4 cm H2O per 2 cm increase in AC (CI = 0.2, 0.7, p < 0.01). Intravesical pressure (Pves) at MCC increased 0.4 cm H2O per 2 cm increase in AC (CI = 0.0, 0.8, p = 0.05) but was not associated with BMI (p = 0.18). BMI and AC had a stronger association with Pabd than with Pves, suggesting a possible mechanism for the association
between obesity and urinary incontinence. 相似文献
8.
Sexual Function in Women with and without Urinary Incontinence and/or Pelvic Organ Prolapse 总被引:8,自引:5,他引:3
G. R. Rogers A. Villarreal D. Kammerer-Doak C. Qualls 《International urogynecology journal》2001,12(6):361-365
The sexual function of women with and without urinary incontinence and/or pelvic organ prolapse (UI/POP) was compared using
a condition-specific validated questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ).
Eighty-three women with UI/POP and 56 without agreed to participate. PISQ scores were significantly lower among women with
UI/POP than in those without (P = 0.003). No differences in the stages of sexual excitement were noted between groups. The frequency of intercourse was less
with UI/POP than without (P = 0.04). Women with UI/POP restricted sexual activity for fear of losing urine more frequently than did those without (P= 0.005). No differences were reported in patients’ or partners’ sexual satisfaction. This study found that women with UI/POP
have poorer sexual functioning than those without, as measured by the PISQ, and report less frequent sexual activity. In
addition, women with UI/POP are more likely to restrict sexual activity for fear of incontinence, although they report similar
levels of satisfaction with their sexual relationships as do women without UI/POP. 相似文献
9.
Daniel M. Morgan Rodney L. Dunn John T. Stoffel Dee E. Fenner John O. L. DeLancey Edward J. McGuire John T. Wei 《International urogynecology journal》2008,19(4):509-515
We sought to determine if postoperative urinary incontinence (UI) symptoms are associated with (1) sexual activity status
and (2) sexual function using validated health-related quality of life instruments. In this mailed cross-sectional survey
of 687 women who underwent stress incontinence surgery, 437 (63.6%) completed a questionnaire protocol. Clinical and sociodemographic
factors independently associated with sexual activity status were identified with logistic regression. Sexually active respondents completed the Pelvic Organ Prolapse and Urinary Incontinence
Sexual Function Questionnaire (PISQ-12) as a measure of sexual function. Factors independently associated with sexual function were identified with linear regression. Sexual activity was reported
by 57.6% (252/437). The likelihood that a respondent was sexually active was moderated by an interaction between age and UI
symptom severity (p = 0.059). Among the sexually active women, increasing UI symptom severity was associated with poorer sexual function (r = −0.42, p < 0.001). The severity of postoperative recurrent or persistent UI is associated with a lower probability of being sexually
active and an adverse effect on sexual function. 相似文献
10.
The aim of the study was to examine the 1-year urodynamic outcome and quality of life in patients who have had concomitant tension-free vaginal tape insertion during pelvic floor reconstruction surgery. The medical notes of a retrospective cohort of 45 patients who had undergone tension-free vaginal tape together with pelvic floor reconstruction surgery were reviewed. The operative information, the results of the urodynamic studies and the change in the quality-of-life scores 1 year after surgery were examined. The quality of life was assessed with both general and disease-specific quality-of-life questionnaires (General Health Questionnaire (GHQ-12), Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7)). Patient satisfaction was assessed with the validated Chinese version of the Client Satisfaction Questionnaire (CSQ). Forty-five patients underwent tension-free vaginal tape insertion together with pelvic floor reconstruction surgery. The overall objective cure rate was 43%. There was a significant improvement in the disease specific quality-of-life assessment (UDI-6 score 38.3–15.5; P<0.01) and (IIQ-7 score 15.0–4.0; P<0.01). The patients who had a concomitant cystocele repair had a worse objective cure rate than patients without concomitant cystocele repair (38% vs 67%; P=0.19).Abbreviations SUI Stress urinary incontinence - TVT Tension-free vaginal tapeEditorial Comment: This retrospective cohort study compared objective cure rates (negative stress test and normal cystometry) and quality of life surveys among patients who underwent concomitant tension-free vaginal tape procedures and cystocele repair with those undergoing TVT procedures alone. At 1 year, the reported success rate of the combine procedures was 37% as compared to 67% for those patients undergoing TVT alone. These rates are lower than those reported in most previous studies. Without more information concerning pre- and post-operative urodynamic evaluations and techniques employed in the cystocele repair, it is difficult to explain the differences in outcomes from those reported by other authors. Prospective randomized trials are needed to evaluate the long-term cure rates and complication rates of TVT combined with cystocele repair in order to formulate clinical recommendations for future practice. 相似文献
11.
Robert A. Catania Stephen M. Kavic J. Scott Roth Tommy H. Lee Tanya Meyer George T. Fantry Paul F. Castellanos Adrian Park 《Journal of gastrointestinal surgery》2007,11(12):1579-1588
Introduction The utility of laparoscopic Nissen fundoplication in the treatment of laryngopharyngeal reflux symptoms remains controversial.
We hypothesized that a carefully selected population with these symptoms would benefit from antireflux surgery.
Materials and Methods Sixty-one consecutive patients have undergone antireflux surgery for laryngopharyngeal reflux at a single institution. Preoperative
evaluation including upper endoscopy, laryngoscopy, and 24-h ambulatory pharyngeal pH probe monitoring confirmed the diagnosis.
Patients completed two validated symptom assessment instruments preoperatively and at multiple time points postoperatively.
Results Patients were followed for up to 3 years with a mean follow-up of 15.2 months. A significant improvement in reflux symptom
index score (preoperative = 31.5 ± 7.4 vs 3 years = 12.4 ± 10.9, p < 0.01), laryngopharyngeal reflux health-related quality of life overall score (preoperative = 55.0 ± 26.0 vs 3 years = 11.3 ± 13.9,
p < 0.01), and symptom domain scores (voice, cough, throat clearing, and swallowing) occured within 1 month of surgery and
remained improved over the course ofthe study.
Conclusion Laparoscopic Nissen fundoplication is effective in relieving the symptoms of laryngopharyngeal reflux in a carefully selected
patient population. Benefits are seen within 1 month of surgery and persist for at least 3 years.
Presented at the Digestive Disease Week 2007, May 22, 2007, Washington, DC. 相似文献
12.
H. P. Dietz A. Kirby K. L. Shek P. J. Bedwell 《International urogynecology journal》2009,20(8):967-972
Introduction and hypothesis The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal
muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms
or signs of bladder dysfunction.
Methods In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for
independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound.
Results Mean age was 55 years (range, 17–87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis
muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models.
Conclusion Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when
controlling for symptoms or signs of prolapse and previous surgery. 相似文献
13.
S. Charalambous S. Touloupidis G. Fatles A.G. Papatsoris Ch. Kalaitzis S. Giannakopoulos V. Rombis 《International urogynecology journal》2008,19(3):357-360
We present comparative short-term experience with the transvaginal (TVT) and the transobturator (TVT-O) approaches for the
treatment of stress urinary incontinence (SUI). We studied 315 women with SUI, treated with a tension-free tape placement.
The TVT approach was applied in 265 women, while 50 women were treated by the TVT-O approach. The mean operation time was
25 and 17 min in the TVT and TVT-O group, respectively (p < 0.001). In the TVT group, continence rates were 87% after 1 year, while in the TVT-O group, the continence rate was 94%.
Postoperative pain was reported in 14.4 and 28% of the TVT and TVT-O patients, respectively (p = 0.02). Complications such as bladder perforation, retropubic hematoma, and urinary retention took place only in the TVT
group. Urinary tract infections were recorded in 20 and 8% of the TVT and TVT-O patients, respectively (p = 0.04), while vaginal erosion took place in 1.5 and 2% and de novo urgency in 14 and 8%. Both approaches show high rates
of cure at the first postoperative year, while complications are less with the TVT-O procedure. 相似文献
14.
Huey-Yi Chen Ming Ho Yao-Ching Hung Li-Chia Huang 《International urogynecology journal》2008,19(1):117-121
The goal of this study was to analyze the risk factors associated with vaginal erosion after synthetic sling procedure for
stress urinary incontinence. Follow-up evaluations were at 1 week, 1 to 3 months, 6 months, and annually after the operation.
The evaluations included detailed history taking, vaginal examinations, and perineal ultrasonographic urethrocystography.
The vaginal erosion rate (6/239) after the synthetic sling procedure was 2.5%. We assessed the relationship between clinical
features and vaginal erosion. Of these, only diabetes mellitus (DM) was a significant risk factor for vaginal erosion. Women
with DM were 8.3 times more at risk than women without DM for developing vaginal erosion after synthetic sling procedure (p < 0.05). The vaginal erosion-free rate during the 24-month follow-up decreased significantly in women with DM. The rate of
vaginal erosion associated with type III multifilamentous polypropylene sling (intravaginal slingplasty) is 10.7% more than
that with type I monofilament polypropylene sling (such as tension-free vaginal tape and inside out transobturator vaginal
tape) (p = 0.054). Women with DM should be informed that vaginal erosion is a possible complication after synthetic sling procedure. 相似文献
15.
G. Alessandro Digesu Stefano Salvatore Charlotte Chaliha Stavros Athanasiou Rodolfo Milani Vik Khullar 《International urogynecology journal》2007,18(12):1439-1443
This study aims to evaluate the changes of overactive bladder symptoms to anterior vaginal wall prolapse repair. Ninety-three
consecutive women with symptomatic anterior vaginal wall prolapse ≥ stage II and coexistent overactive bladder symptoms were
prospectively studied using a urinalysis, urodynamics, King’s Health Questionnaire (KHQ), Prolapse Quality of Life (P-QOL)
questionnaire and pelvic organ prolapse quantification (POP-Q) system before and 1 year after surgery. All women underwent
a standard fascial anterior repair. Postoperatively, urinary frequency, urgency and urge incontinence disappeared in 60, 70
and 82% of women respectively (p value < 0.001). The vaginal examination findings as well as the quality of life of the women assessed using KHQ and P-QOL
significantly improved after surgery (p value < 0.001). This study has demonstrated that anterior vaginal repair does produce significant improvement in overactive
bladder symptoms. A larger longer-term study is required to assess if these changes persist over time. 相似文献
16.
Developing and Validating the International Consultation on Incontinence Questionnaire Bladder Diary
Background
Despite the common use of urinary diaries to assess lower urinary tract symptoms (LUTS), a standardised validated diary does not exist.Objective
To develop a validated urinary diary, using the psychometric validation protocol used in previous International Consultation on Incontinence Questionnaire (ICIQ) modules.Design, setting, and participants
We invited 400 consecutive patients attending the urology department for assessment of LUTS to complete a urinary diary (developed and validated for content in a previous study), and the ICIQ Male or Female LUTS questionnaire.Outcome measurements and statistical analysis
To establish construct validity, the urinary diary was compared with known theories from published literature; to establish criterion validity, the diary was compared with questionnaire responses and/or urodynamic observations. Optimal diary duration was tested by comparing the 4-d diary against shorter durations. Patients completed a second diary after 2–3 wk for test-retest analysis, and a subset receiving sacral nerve stimulation completed the diary before and after treatment for analysis of responsiveness. A variety of statistical tests were used for different stages of the study.Results and limitations
The urinary diaries and ICIQ LUTS questionnaires were completed by 264 patients. Construct validity was established for two of three tested hypotheses. Criterion testing showed good agreement between questionnaire and diary recordings of nocturia (κ = 0.653; p < 0.001; 92.2%) and incontinence (κ = 0.351; p < 0.001; 64.5%), whereas good agreement (κ = 0.378; p < 0.001; 69.2%) was observed between urodynamically proven incontinence and diary reports (n = 104). Diary recordings of urgency showed weak agreement with questionnaire responses (κ = −0.215; p < 0.001; 36%) and urodynamic observations (κ = −0.105; p = 0.256; 43.7%). The 3-d diary explained at least 94% of the total variance of the 4-d diary. A second diary for test-retest analysis was returned by 59 patients, demonstrating fair to excellent agreement (Spearman correlations: 0.49–0.88). Pre- and post-treatment analysis, on pilot testing, showed that the diary is responsive to change.Conclusions
Using the ICIQ psychometric validation methodology, a bladder diary was developed for the assessment of LUTS and shown to be valid, reliable, and responsive to change. The 3-d diary has been accepted as the ICIQ bladder diary.Patient summary
In this study, patients and clinicians developed and tested a diary in which patients can record their urinary symptoms. The resulting 3-d diary is called the ICIQ bladder diary and is available for adult men and women with urinary symptoms. 相似文献17.
D. N. Samarasekera M. T. Bekhit J. P. Preston C. T. M. Speakman 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(3):535-538
Background and aims The objective of our study was to analyse the risk factors in a cohort of women who suffered anal sphincter disruption (third-degree
tear) and compare the results with a similar cohort of women who underwent an uncomplicated vaginal delivery (without a clinically
detectable laceration) during the same period.
Materials and methods A retrospective analysis was carried out on 54 women (group 1) who suffered a third-degree tear and 71 women who had undergone
uncomplicated vaginal delivery during the same period (group 2). The risk factors considered were forceps delivery, parity,
second stage of labour longer than 1 h, episiotomy, birth weight over 4 kg, gestational age and maternal age at delivery.
The Cleveland Incontinence Score was completed.
Results Multiple logistic regression analysis of obstetric risk factors for third-degree perineal tear indicated forceps delivery
(p = 0.0001), primiparity (p = 0.004), foetal birth weight over 4 kg (p = 0.030) and delay in the second stage of labour (p = 0.031) to be significant risk factors for a third-degree tear. Mediolateral episiotomy was shown to be a significant protective
factor (p = 0.0001). Gestational age and the maternal age at delivery (p = 0.340) were not shown to be significant risk factors (p = 0.336).
Conclusion Primary prevention and identification of women with risk factors is recommended. In some cases, counselling regarding the
potential risks and benefits of both vaginal and caesarean delivery may be appropriate. 相似文献
18.
Lindsay B. Killingsworth Thomas L. Wheeler II Kathryn L. Burgio Tovia E. Martirosian David T. Redden Holly E. Richter 《International urogynecology journal》2009,20(9):1103-1108
Introduction The purpose of this study was to assess the impact of body mass index (BMI) on tension-free vaginal tape (TVT) success rates,
patient satisfaction, and complications 1 year following surgery.
Methods Baseline and 1-year postsurgery outcomes were abstracted, including Urogenital Distress Inventory (UDI-6) scores, Incontinence
Impact Questionnaire (IIQ-7) scores, and patient satisfaction ratings. Multivariable logistic and linear regression analyses
were performed to examine relationships between outcomes and BMI.
Results Subjects (N = 195) with a mean age of 59.3 ± 12.6 were included. There was significant improvement within each group (all p values <0.01) in total UDI-6 and IIQ-7 scores from baseline to 1 year postsurgery; all groups had high patient satisfaction.
No differences in improvement or complications rates were observed among the BMI cohorts (all p values >0.05).
Conclusion Differential counseling of overweight or obese women regarding outcomes of the TVT procedure is not supported by these results;
longer follow-up is warranted.
Poster presentation Annual Meeting of the Society of Gynecologic Surgeons, April 2009.
Partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases DK068389 to HER. 相似文献
19.
Kyu-Sung Lee Myung-Soo Choo Young Sook Lee Ji-Yeon Han Ji-Yoon Kim Byung Joo Jung Deok Hyun Han 《International urogynecology journal》2008,19(4):577-582
The aim of this study was to prospectively compare the efficacy and safety of ‘inside–out’ (TVT-O) and ‘outside–in’ (TOT)
transobturator tape procedures for treatment of female stress urinary incontinence (SUI). One hundred women with SUI were
alternately assigned to TVT-O (n = 50) or TOT (n = 50). About 1 year after surgery, we compared surgical outcomes in the two groups. TVT-O and TOT showed similar rates of
cure (86 vs 92%). Approximately 1 year after surgery, Incontinence Quality of Life questionnaire parameters improved significantly
in both groups (p < 0.05), but the two groups did not differ (p > 0.05). The rates of patient satisfaction with TVT-O and TOT (96 vs 98%) were similar. These preliminary results suggest
that TVT-O and TOT are equally effective and safe procedures for women with SUI. However, this study was unable to identify
a difference between the two procedures due to the underpowered nature of the study. 相似文献
20.
The purpose of this study is to evaluate the ability of preoperative urodynamic urethral function parameters to predict the
success rate of transobturator slings (TOS). Seventy women urodynamically diagnosed with stress incontinence with urethral
hypermobility underwent a Monarc™ TOS (American Medical Systems, Minnetonka, USA). Postoperative continence status was correlated
with preoperative urodynamic urethral function parameters. Mathematical modeling was used to determine whether urodynamic
parameters can be used to predict postoperative continence. Average follow-up was 8.1 (6–12) months; 56 (80%) patients were
continent based on a standardized stress test and subjective report. The median Valsalva leak point pressure at 150 cc (VLPP150) in the failures and successes was not different (p = 0.12). The median VLPP at cystometric capacity (VLPPcap) in the failures was 32 cmH2O compared to 71 cmH2O in the successes (p < 0.001). The maximum urethral closure pressure (MUCP) had a median of 20 cmH2O in the failures and 45 cmH2O in the successful patients (p < 0.001). No correlation existed between the degree of urethral hypermobility, as measured by the cotton swab test, and surgical
success (p = 0.17). There was no correlation between level of preoperative urethral function and persistent overactive bladder symptoms,
post-void residual, voids/day, and nocturia. Using a combined model, the cutoff values of VLPPcap > 60 cmH2O and MUCP > 40 cmH2O were the most predictive of surgical success, revealing a sensitivity of 83% (0.55, 0.95) and specificity of 79% (0.67,
0.88). A combination of urodynamic parameters can be used to predict continence rates after a TOS. A TOS should be used with
caution in women with impaired urethral function.
G. Willy Davila is a consultant to American Medical Systems. 相似文献