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71.
Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database 下载免费PDF全文
72.
Serati M Ghezzi F Cattoni E Braga A Siesto G Torella M Cromi A Vitobello D Salvatore S 《European urology》2012,61(5):939-946
Background
One of the most effective and popular current procedures for the surgical treatment of stress urinary incontinence (SUI) is tension-free midurethral slings.Objective
To evaluate the outcomes of women with retropubic tension-free vaginal tape (TVT) for urodynamic stress incontinence (USI) after 10-yr follow-up.Design, setting, and participants
This was a prospective observational study. Consecutive women with proven USI were treated with TVT. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.Intervention
Standard retropubic TVT.Measurements
Patients underwent preoperative clinical and urodynamic evaluations. During follow-up examinations, women were assessed for subjective satisfaction and objective cure rates. Multivariable analyses were performed to investigate outcomes.Results and limitations
A total of 63 women were included. After 10 yr, 5 patients (8%) were lost or no longer evaluable. The 10-yr subjective, objective, and urodynamic cure rates were 89.7%, 93.1%, and 91.4%, respectively. These rates were stable across the whole study period (p > 0.99). De novo overactive bladder was reported by 30.1% and 18.9% of patients at 3-mo and 10-yr follow-up, respectively (p for trend = 0.19). A total of 84.2% of women with detrusor overactivity received antimuscarinic drugs, but 43.8% were nonresponders 12 wk later. At multivariable analysis, maximum detrusor pressure during the filling phase >9 cm H2O (hazard ratio [HR]: 16.2; p = 0.01) and maximum detrusor pressure during the voiding phase ≤29 cm H2O (HR: 8.0; p = 0.01) were independent predictors for the recurrence of SUI, as well as obesity was for the recurrence of objective SUI (HR: 17.1; p = 0.01) and of USI (HR: 8.9; p = 0.02), respectively. Intraoperatively, bladder perforation occurred in two cases; no severe bleeding or other complications occurred.Conclusions
The 10-yr results of this study seem to demonstrate that TVT is a highly effective option for the treatment of female SUI, recording a very high cure rate with low complications after a 10-yr follow-up. 相似文献73.
A.M. Abdelbary 《The African Journal of Urology》2012,18(4):175-179
ObjectiveTo determine the efficacy, safety and urodynamic effects of the Martius flap and the anterior vaginal wall sling in treating post-birth trauma in the form of urethra-vaginal fistula (UVF) associated with stress urinary incontinence (SUI).Patients and methodsBetween July 2006 and August 2011, 19 patients underwent repair of UVF by interposition of a Martius flap and correction of associated SUI by a modified anterior vaginal wall sling. The procedure was carried out 3–17 (mean 7) months after post-birth trauma. Pre-operative evaluation consisted of history, voiding diary, physical examination, routine laboratory work-up, abdominopelvic ultrasonography, intravenous urography (IVU), and cystourethrography. The patients were followed up for a mean of 34 months. Follow-up included history, physical examination, urine analysis and pelvic ultrasonography for the assessment of residual urine. Urodynamic evaluation was performed at 3 months post-operatively.ResultsNone of the patients developed recurrence of UVF. SUI was corrected in 16 patients (84%). In the post-operative period, 3 patients (16%) complained of an overactive bladder (OAB) with urodynamic detrusor overactivity (DO) and an obstructed flow. These problems were managed successfully using anticholinergics and urethral dilation. Three patients (16%) complained of mild SUI, but refused further management. Within 3 years following the intervention, 3 patients complained of a recurrence of SUI which was managed successfully by a rectus sheath sling.ConclusionsPatients with a post-birth trauma in the form of UVF should be examined intra-operatively for the presence of associated SUI following correction of UVF. The use of the Martius flap and anterior vaginal wall sling in treating such patients is safe, efficient and reproducible. An anterior vaginal wall sling should be avoided in distal UVF to avoid recurrence of SUI. 相似文献
74.
Steven E. Schraffordt Koops Tanya M. Bisseling H. Jorien van Brummen A. Peter M. Heintz Harry A. M. Vervest 《International urogynecology journal》2007,18(4):437-442
This study assessed the long-term outcome of tension-free vaginal tape (TVT) in women with concomitant pelvic surgery. A prospective
cohort study of 746 patients in 41 hospitals was undertaken. The Incontinence Impact Questionnaire (IIQ-7) and Urogenital
Distress Inventory (UDI-6) were used to measure the results of the TVT. Fifty-nine patients with concomitant prolapse surgery
were compared with 687 women with TVT only. The decrease in IIQ/UDI mean scores were statistically significant in both groups
after the TVT. The success rates of “no leakage at all” is comparable for both groups. This study, with 54 gynecologists and
urologists participating, showed the long-term (2 years) success rates of TVT with concomitant prolapse surgery. It shows
that the procedure in conjunction with prolapse surgery can be safely performed with good results. 相似文献
75.
Baoyan Liu Yan Liu Zongshi Qin Kehua Zhou Huangfang Xu Liyun He Ning Li Tongsheng Su Jianhua Sun Zenghui Yue Zhiwei Zang Wei Zhang Jiping Zhao Zhongyu Zhou Lian Liu Dongning Wu Jiani Wu Jing Zhou Zhishun Liu 《Mayo Clinic proceedings. Mayo Clinic》2019,94(1):54-65
Objective
To evaluate the efficacy and safety of electroacupuncture vs pelvic floor muscle training (PFMT) plus solifenacin for women with mixed urinary incontinence (MUI).Patients and Methods
This randomized controlled noninferiority trial was conducted at 10 hospitals in China between March 1, 2014, and October 10, 2016. Participants were randomized 1:1 to receive electroacupuncture (36 sessions) over 12 weeks with 24 weeks of follow-up or PFMT-solifenacin (5 mg/d) over 36 weeks. The primary outcome was percentage change from baseline to week 12 in mean 72-hour incontinence episode frequency (IEF) measured by the 72-hour bladder diary. It was analyzed in the per-protocol set with a prespecified noninferiority margin of 15%.Results
Of 500 women with MUI who were randomized, 467 (239 in the electroacupuncture group and 228 in the PFMT-solifenacin group) completed treatment per protocol and were included in the primary outcome analysis. At weeks 1 through 12, the percentage of reduction from baseline in mean 72-hour IEF was 37.83% in the electroacupuncture group and 36.49% in the PFMT-solifenacin group (between-group difference, ?1.34% [95% CI, ?9.78% to 7.10%]; P<.001 for noninferiority), which demonstrates noninferiority; the treatment effect persisted throughout follow-up. Statistically significant improvements were found for secondary outcomes in both groups, with no meaningful difference between treatments.Conclusion
In women with moderate to severe MUI, electroacupuncture was not inferior to PFMT-solifenacin in decreasing the 72-hour IEF and shows promise as an effective alternative for the treatment of MUI.Trial Registration
clinicaltrials.gov Identifier: NCT02047032. 相似文献76.
Maurizio Serati Andrea Braga Elena Cattoni Gabriele Siesto Antonella Cromi Fabio Ghezzi Stefano Salvatore 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women.Study design
Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥70 years old) were included in group 1, while younger women (<70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups.Results
During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15–41) months for the younger and 25 (IQR 18–40) months for older patients (p > 0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p = 0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p = 0.44).Conclusions
TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population. 相似文献78.
79.
80.
目的:观察基于经筋理论的透刺法结合滞针术治疗女性轻、中度压力性尿失禁(stress urinary incontinence,SUI)的临床疗效。方法:77例轻、中度SUI女性患者随机分为观察组38例,对照组39例。观察组使用透刺法,并施以滞针术;对照组使用普通针刺法;两组均配合盆底肌训练(pelvic floor muscle training,PFMT)。于治疗前后记录24 h漏尿事件发生次数,于治疗前及治疗期间的第4周、第8周、第12周进行尿失禁影响问卷简版(incontinence impact questionnaire short form,IIQ-7)、国际尿失禁咨询委员会尿失禁问卷简表(international consultation committee on incontinence questionnaire short form,ICI-Q-SF)调查。结果:治疗12周后,观察组及对照组的漏尿事件发生次数均显著低于治疗前(P<0.01),且观察组漏尿事件发生次数均显著低于对照组(P<0.05)。观察组和对照组的IIQ-7评分、ICI-Q-SF评分在治疗4周、8周、12周逐渐降低,且与各组治疗前比较,差异均有统计学意义(P<0.01);在治疗第8周和第12周时,观察组和对照组比较,差异有统计学意义(P<0.01)。观察组有效率为94.74%,对照组有效率为74.36%,两组比较,差异有统计学意义(P<0.05)。结论:基于经筋理论的透刺法结合滞针术治疗轻、中度女性压力性尿失禁临床疗效显著,可显著降低漏尿事件发生次数,降低IIQ-7评分、ICI-Q-SF评分。 相似文献