两种非手术方式对围绝经期女性压力性尿失禁治疗的临床研究

目的：探讨围绝经期女性压力性尿失禁有效、经济的治疗方法。方法：选取40例围绝经期压力性尿失禁随机分为2组，A组用电刺激加生物反馈治疗，B组单纯kegel训练治疗，另有10例对照。结果：A组治疗后尿失禁程度、盆底肌力、漏尿情况均明显好转近似治愈（P〈0．01），B组治疗后尿失禁程度、盆底肌力、漏尿情况均有改善（P〈0．05），C组对照组2个月后无明显变化，2个月后三组之间均有显著性差异。结论：电刺激加生物反馈治疗和单纯kegel训练治疗均对围绝经期女性压力性尿失禁治疗有效，但前者优于后者。     

Mid‐urethral synthetic slings in the treatment of urodynamic female stress urinary incontinence without concomitant pelvic prolapse repair: 4‐year health‐related quality of life outcomes

Study Type – Therapy (outcomes research)
Level of Evidence 2c

OBJECTIVE

To report 4‐year health‐related quality of life (HRQL) outcome data after retropubic mid‐urethral synthetic sling (MUS) surgery without concomitant prolapse repair for treating female stress urinary incontinence (SUI) in a single institution.

PATIENTS AND METHODS

The data were prospectively collected, which yielded 21 consecutive patients with a mean (range) age of 67.6 (41–81) years who underwent retropubic MUS with ≥4 years follow‐up. Before surgery, all patients underwent history, examination, pad usage, and multichannel fluoroscopic urodynamics according to International Continence Society standards. In all, 19 patients had urethral hypermobility with an abdominal leak‐point pressure (ALPP) of >90 cmH₂0 and two had intrinsic sphincter deficiency with an ALPP of <60 cmH₂0. The MUS were all placed under no tension. All patients were cystoscoped with both 30 and 70° lens at the end of the procedure with a fully distended bladder to exclude bladder or urethral injury. The validated Kings Health Questionnaire (KHQ) was used both before and after surgery to assess HRQL measures. All patients were assessed at 3 months, and then at least three times thereafter.

RESULTS

The paired Student’s t‐test was used on the mean KHQ scores before and after MUS surgery (4 years follow‐up). There were statistically significant improvements in all nine domains on the KHQ between preoperative and 3 months after MUS surgery (P < 0.01), with the most significant being in ‘General Health Perceptions’, ‘Incontinence Impact’, ‘Physical Limitations’, and ‘Role Limitations’. Improvement in HRQL persisted up to 4 years in all domains. Bladder perforation occurred in two patients with uneventful resolution. Two patients required very short‐term catheterization (<5 days). In the present series, there was no sling revision, division, infection or erosion. No patients developed de novo urgency or urge UI after MUS surgery. The pad‐free rate in the present series was 85.7%.

CONCLUSION

In our institution, HRQL improvement at 3 months after retropubic MUS surgery predicts persistence of improvement at 4 years. This is useful clinically in counselling our patients for treatment efficacy. Tension‐free placement is associated with minimal risk of postoperative retention or de novo overactive bladder. Although patient numbers are modest, these data contribute to the scarce longer term (≥4 years) HRQL data on the MUS, which is a safe and durable procedure with a minimal complication profile.     

女性盆腔脏器脱垂的尿动力学分析

目的探讨女性盆腔脏器脱垂（pelvic organ prolapse,POP）的尿动力学特点,了解盆腔脏器脱垂与压力性尿失禁（stress urinary incontinence,SUI）的关系。方法对2006年1月至2008年12月在本院就诊的53例女性盆腔脏器脱垂患者,采取1996年国际节制协会公布的盆腔脏器脱垂评估分类法（pelvic organ prolapse quantitative examination,POP-Q）,进行尿动力学检查,测定尿动力学参数,并对结果进行统计学分析。根据国际尿控协会（International Continence Society,ICS）制定的标准,对压力性尿失禁进行分型（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象的知情同意,并与之签署临床研究知情同意书）。结果53例盆腔脏器脱垂患者中,合并压力性尿失禁为38例（Ⅰ型压力性尿失禁为18例,Ⅱ型为12例,Ⅲ型为8例）（71．7％,38／53）,混合性尿失禁为5例（9．4％,5／53）。结论盆腔脏器脱垂与压力性尿失禁密切相关。尿动力学检查在对女性盆腔脏器脱垂的指导治疗方面具重要意义。     

Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure?

In the last few years, the Burch colposuspension and the fascial slings were often defined from the pages of the most relevant journals of general medicine, as gold-standard procedures for the surgical treatment of stress urinary incontinence (SUI), whereas mid-urethral slings (tension-free vaginal tape (TVT) and tension-free vaginal tape obturator) were attributed a marginal and almost experimental role in this field. This poorly reflect the current scenario of the surgical management of SUI: Recently, a number of meta-analysis have demonstrated that TVT is significantly more effective if compared to colposuspension and that it is followed by significantly lower perioperative morbidity if compared to pubovaginal slings. It is not realistic to suggest to general practitioners that the surgical gold standard for SUI includes the performance of a wide laparotomy, long hospital stays and a high risk of long-lasting intermittent self-catheterisation. This would inevitably discourage women from embarking on surgical treatment, which instead could actually improve their quality of life.     

益髓生血灵对β-珠蛋白生成障碍性贫血患儿促红细胞生成素的影响

目的　探讨益髓生血灵对 β 珠蛋白生成障碍性贫血 (β 地贫 )患儿促红细胞生成素 (EPO)的影响。方法　应用酶联法检测 8例重型 β 地贫和 17例中间型β 地贫患者采用益髓生血灵治疗 3个月前后血清EPO含量。结果　重型和中间型 β 地贫组患者治疗后血红蛋白 (Hb)、红细胞 (RBC)、胎儿血红蛋白 (HbF)和网织红细胞 (Ret) 4项指标均较治疗前明显提高 ,差异有显著意义 (P <0 .0 0 1) ;而重型和中间型 β 地贫组患者治疗后EPO含量较治疗前有所下降 ,其中重型 β 地贫组 (91.5 3± 3.19/ 89.14± 3.76 )pg/ml差异无统计学意义 (P >0 .0 5 ) ,中间型 β 地贫组 (82 .5 3± 11.6 3/ 79.85± 10 .82 ) pg/ml差异有统计学意义 (P <0 .0 5 )。 结论　益髓生血灵治疗β 地贫不是通过刺激EPO分泌来改善贫血 ,对 β 地贫红系造血可能有综合调控作用     

盆底动态核磁共振在女性压力性尿失禁合并盆腔器官脱垂患者诊断评估中的临床价值

目的探讨盆底动态核磁共振(dynamic magnetic resonance imaging,dMRI)在女性压力性尿失禁(stress urinary incontinence,SUI)合并盆腔器官脱垂(pelvic organ prolapse,POP)患者中的鉴别和诊断的价值。方法选取2018年2月至2019年2月恩施州中心医院妇科经查体确诊的35例SUI合并POP患者和同期同年龄段的25例SUI患者为研究对象。将35例SUI合并POP患者设为观察组,25例SUI患者设为对照组。两组患者均行1.5T dMRI检查和经会阴超声检查,从横断位、矢状位、冠状位影像,测量其膀胱尿道后角、尿道长度、尿道倾斜角、H线和盆膈裂孔横径指标情况;分析比较dMRI在单纯SUI和SUI合并POP中的鉴别和诊断价值,探究dMRI检查与POP分级的一致性情况。结果观察组和对照组患者静息相经会阴超声、dMRI诊断的尿道长度、膀胱尿道后角、尿道倾斜角、α角等参数比较,其差异均无统计学意义(均P>0.05);两组患者力排相dMRI检查测量的膀胱尿道后角、α角略高于超声测量数据,其差异均具有统计学意义(均P<0.05)。观察组患者dMRI静息相、力排相H线、盆膈裂孔横径2项参数差异均具有统计学意义(均P<0.05);dMRI在诊断观察组前盆腔、中盆腔脏器脱垂严重程度与POP-Q体格检查一致性良好。结论 dMRI相对于传统经会阴超声诊断技术在SUI合并POP检查中,可以更精确地测量盆底相关参数,清晰显示盆底支持结构功能状态,可以准确鉴别SUI、SUI合并POP,并且准确评估盆腔脏器脱垂程度,值得临床推广应用。     

Application of ultra pulse CO2 lattice laser in the treatment of female urinary incontinence

BackgroundThis study aimed to explore the application of CO₂ lattice laser in the treatment of mild and moderate urinary incontinence in female patients.MethodsWe analyzed the clinical data of 33 female patients with mild to moderate urinary incontinence from a prospective cohort study, who were treated with FemiLift CO₂ lattice laser instrument (Alma Laser Ltd, Caesarea, Israel) at our hospital from January 2018 to December 2018. All the female patients were married and fertile, with a mean age of (43.15±6.49) years old (35–62 years old). There were 18 participants with mild urinary incontinence and 15 with moderate urinary incontinence. All participants received laser treatment 3 times, with an interval of 30 days. The International Consultation of Incontinence Questionnaire- Short Form (ICIQ-SF) survey was conducted before the treatment, 3 months after, and 6 months after the treatment. A 1-hour urine pad test was used to quantify the leakage of urine. Residual urine and urine routine examination were performed to exclude other combined diseases.ResultsAfter 3 times of treatment with FemiLift CO₂ laser, 13 cases were cured in 3 months, and 16 cases were cured in 6 months. 10 cases and 15 cases were significantly improved in 3 or 6 months, respectively. 2 patients had no significant changes, and no adverse reactions were recorded. The pad test showed that the symptom of all 33 patients were significantly improved, and the average scores of ICIQ-SF were significantly decreased (P<0.05) from 12.36 (Grade I) and 15.67 (Grade II) (5-21) before treatment to 3.73(Grade I) and 5.49 (Grade II) (1-12) after 6 months of therapy.ConclusionsThe CO₂ lattice laser is safe and effective in the treatment of mild and moderate urinary incontinences in female patients, which can effectively improve the symptom of urinary leakage without obvious adverse reactions.