Efficacy of optimized pelvic floor training of YUN combined with pelvic floor magnetic stimulation on female moderate stress urinary incontinence and sexual function: a retrospective cohort study

BackgroundOwing to its tediousness and monotony, traditional pelvic floor muscle training (PFMT) is difficult to ensure the correctness of exercise, and it is difficult for patients to adhere to treatment. We designed this study to evaluate and analyze the efficacy of optimized pelvic floor training of YUN combined with pelvic floor magnetic stimulation on female moderate stress urinary incontinence (SUI) and sexual function.MethodsThis is a retrospective cohort study. This study was carried out in 95 female patients with moderate SUI. The inclusion criteria were as follows: premenopausal women aged 25–45; moderate SUI; over 3 months of disease duration; informed consent and cooperation with treatment and follow-up. The participants in group 1 (control group, n=46) were treated with pelvic floor magnetic stimulation, while those in group 2 (trial group, n=49) were treated with pelvic floor magnetic stimulation combined with optimized pelvic floor training of YUN. Evaluations were scheduled before the treatment (0 week), after 6 weeks of treatment (6 weeks), and after 12 weeks of treatment (12 weeks). And compare the differences between the two groups.ResultsThere was no significant difference in age, body mass index (BMI), duration of disease, and abdominal leak point pressure (ALPP) between the two groups (P>0.05). The total effective rate of the trial group was higher than that of the control group (89.80%, 44/49 vs. 78.26%, 36/46) (P<0.05). The electromyographic values, the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score, physiological factors, and emotional factors were all improved significantly in both groups after active treatment, and the improvement of the trial group was more obvious (P<0.05).ConclusionsOptimized pelvic floor training of YUN combined with pelvic floor magnetic are more effective for the treatment of female moderate SUI and sexual function. It has become a safe, effective, and well tolerated new type of pelvic floor functional reconstruction training method with good patient compliance.     

Management of complications of mesh surgery

Polypropylene mesh (PPM) has been used in abdominal sacrocoplopexies since the 1990's however following a patient led campaign controversy surrounds its use incontinence procedures, midurethral slings (MUS) and vaginal mesh prolapse repairs. The complication rates following mesh surgery may be as high as 10%. NHS England paused the vaginal insertion of polypropylene mesh in July 2018 pending a review by Baroness Cumberledge. This review will outline the assessment and basic management of complications of polypropylene mesh. This is a relatively new area of urogynaecological practice which non-specialist obstetric and gynaecology clinicians and GPs need to be aware of. Symptoms which could be due to mesh complications are vaginal discharge or bleeding, recurrent urinary tract infection, haematuria, dyspareunia and pelvic pain. Women presenting with any of the above symptoms should be asked if they have had previous surgery for stress incontinence or prolapse. The women may not recall having mesh inserted and may use different terms “sling” “net” or “tape”. They should be examined to both look and feel for PPM. Mesh complications should be managed by the designated mesh centres which are listed on the BAUS and BSUG websites. All mesh complications should be reported to the Medicines & Healthcare products Regulatory Agency (MHRA) by the yellow card system. All mesh complications requiring further surgical intervention should be recorded on the British Society of Urogynaecology (BSUG) national database.     

女性压力性尿失禁的治疗进展

压力性尿失禁（ SUI）是中老年妇女的常见病,且随着个体年龄增加而增加,全球妇女该病患病率为10％～23％,中国成年女性患病率为18．9％。严重影响女性身心健康和生活质量,已成为社会公共卫生问题。随着我国人口老龄化,SUI发病率逐步增高,人们对生活质量的要求逐渐提高,SUI的诊治正日益受到重视。目前治疗SUI的方法分为保守治疗和手术治疗,本文就女性压力性尿失禁的治疗进展进行综述。     

头针结合骶四针治疗女性压力性尿失禁临床研究

目的:通过盆底肌电生理检查测定头针结合"骶四针"疗法治疗后盆底表面肌电值,为针刺治疗女性压力性尿失禁(SUI)的临床疗效提供客观依据。方法:选取女性SUI患者62例,按随机数字表法分为研究组32例和对照组30例。对照组采用盆底生物反馈电刺激疗法结合凯格尔训练,研究组在对照组基础上加用头针结合骶四针疗法。治疗4周后比较2组患者的盆底表面肌电值、1h尿垫试验尿失禁量和ICI-Q-SF量表评分。结果:治疗前,2组盆底表面肌电值比较,差异无统计学意义(P>0.05)。治疗后,2组盆底表面肌电值较治疗前升高,且研究组盆底表面肌电值高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组1 h尿垫试验尿失禁量比较,差异无统计学意义(P>0.05)。治疗后,2组1 h尿垫试验尿失禁量较治疗前降低,且研究组1 h尿垫试验尿失禁量小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组ICI-Q-SF量表评分比较,差异无统计学意义(P>0.05)。治疗后,2组ICI-Q-SF量表评分较治疗前降低,研究组ICI-Q-SF量表评分低于对照组,差异均有统计学意义(P<...     

合成材料吊带与尿道中段悬吊术后并发症的关系

 尿道中段悬吊术是中到重度压力性尿失禁(stress urinary incontinence,SUI)患者以及保守治疗效果不佳者的最佳治疗选择,合成材料吊带是尿道中段悬吊术最常用的材料,而该手术后的并发症(如吊带侵蚀、疼痛、尿道感染等)正在越来越受到重视。本文综述了尿道中段悬吊术及合成材料吊带的产生与发展、比较了不同种类合成材料在吊带的规格、力学性质、材料、编制方法、涂层上等因素的区别及其与上述并发症的关系,以期为临床医师在合成吊带的选择上提供参考。     

Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly’s plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it’s routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.