Sling incision with associated vaginal wall interposition for obstructed voiding secondary to suburethral sling procedure

Obstructed voiding is a well recognized complication following a suburethral sling procedure. Current methods of transvaginal and transabdominal urethrolysis have had variable success rates in relieving the obstruction, and do not restabilize the urethra to prevent potential postoperative stress incontinence. We report on a procedure used in 4 cases which addresses both of these issues. All patients had persistent urinary retention beyond 8 weeks after a suburethral sling procedure. An oupatient procedure consisting of sling incision and associated tissue interposition (vaginal wall in three cases and fascia lata in one) was successful in relieving the obstruction. Continence status was maintained in 3 of the 4 patients. There were no major complications of this outpatient procedure.     

基于姿势解密技术的手法治疗青少年特发性脊柱侧弯的疗效观察

目的 观察基于姿势解密技术的手法治疗青少年特发性脊柱侧弯（AIS）的临床疗效。 方法 选取36例AIS患者随机分为观察组和对照组,每组18例,但治疗期间,因个人原因观察组脱落1例,对照组脱落2例,最终完成本研究33例。2组患者均采用侧移训练矫正疗法作为常规康复训练,侧移训练每周4次,每次训练10 min,共治疗4周;在此基础上,观察组增加姿势解密技术手法治疗,对照组则增加悬吊训练治疗,每周治疗1次（错开侧移训练日）,每次治疗20 min,共治疗4周。分别于治疗前和治疗4周结束后（治疗后）,对2组患者的脊柱侧方弯曲度（Cobb角）、锁骨角（CA）、躯干旋转角（ATR）、椎体旋转度（VR）、脊柱侧凸研究会患者问卷表22项(SRS-22) 进行评估。 结果 治疗后,观察组患者的Cobb角［（16.76±6.67）°］、锁骨角［（1.35±0.50）°］、ATR［（6.18±3.23）°］和SRS-22评分［（88.18±5.47）分］均较组内治疗前［（20.12±6.98）°、（2.53±1.20）°、（8.65±4.15）°、（84.65±6.76）分］有明显改善（P＜0.05）,对照组的Cobb角［（17.31±6.83）°］、ATR［（6.31±2.52）°］、SRS-22评分［（86.25±10.53）分］较组内治疗前［（18.13±7.08）°、（7.06±2.84）°、（85.00±11.02）］ 明显改善（P＜0.05）,但锁骨角改善并不明显（P＞0.05）;且治疗后观察组的Cobb角、ATR、锁骨角和SRS-22评分的改善程度均明显高于对照组（P＜0.05）。而2组患者的VR改善程度组内及组间比较,差异均无统计学意义（P＞0.05）。 结论 姿势解密技术手法能有效改善AIS患者的脊柱侧弯、肩部失衡程度,有更好的整体治疗效果。     

无张力阴道吊带术治疗压力性尿失禁(附10例报告)

目的探讨无张力阴道吊带术(TVT)的手术方法、适应证及并发症的预防. 方法女性压力性尿失禁(SUI)患者10例,平均年龄52岁.漏尿病史平均7年,其中8例为轻中度SUI,加压期尿道压力>10 cmH2O,2例为重度SUI,加压期尿道压力<10 cmH2O.经阴道前壁行无张力阴道吊带术. 结果 10例SUI均得到满意的控尿效果.1例患者术后剩余尿100 ml,但主观评价明显改善.随访13～21个月,无SUI症状复发,无排尿困难及尿路感染. 结论 TVT是一种简便、快捷的SUI治疗方法,疗效满意,可以减少患者的痛苦和缩短住院时间.     

Transvaginal vs transobturator approach for synthetic sling placement in patients with stress urinary incontinence

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.     

The distribution of different surgical types for female stress urinary incontinence among patients’ age,surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers’ characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996–2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.     

乙酰胆碱、蛙皮素和P物质对人食管下括约肌张力调节的细胞内信号转导机制

目的 观察蛋白激酶C(PKC)和钙调蛋白信号转导通路在乙酰胆碱、蛙皮素和P物质对人食管下括约肌钩状纤维和套索纤维张力调节中的作用.方法 应用PKC信号通路特异性阻断剂H7和钙调蛋白信号通路特异性阻断剂CGS9343B,以食管和胃底环形肌作对照,测定抑制套索纤维和钩状纤维肌细胞收缩的情况.结果 乙酰胆碱与蛙皮素和P物质引起的收缩,应用H7(5±1)%、(5±2)%、(6±2)%和无钙培养(4±1)%、(6±1)%、(3±1)%的方法,可以有效阻断钩状纤维的收缩(22±1)%、(23±1)%、(24±1)%;以CGS9343B(3±1)%、(4±2)%、(6±1)%和4mmol/L锶离子处理(5±2)%、(3±1)%、(6±2)%可以有效阻断套索纤维(23±2)%、(24±2)%、(26±1)%的收缩.结论 人食管下括约肌的套索纤维细胞依赖钙调蛋白信号通路和内源性钙离子释放产生最大收缩效应.钩状纤维细胞依赖PKC信号通路和外源性钙离子流入产生最大收缩效应.     

Endoscopic excision of an eroding calcified mesh sling, 10 years after primary surgery

Management of urethral erosion typically entails two options: sling incision (in the early postoperative period) or excision of the suburethral part of the sling (urethrolysis). This paper describes a different endoscopic technique. A forty-year-old woman with a synthetic sling implanted 10 years prior presented with persistent lower urinary tract symptoms. A kidney ureter bladder X-ray showed a stone at the level of the bladder neck. Disintegration of the stone revealed eroding mesh embedded in the urethral wall. Complete resection of the mesh using an electrocautery knife was performed. Two months since the procedure, the patient has had an uneventful course. Both vaginal and urethral walls are intact, and she is capable of normal voiding with some stress incontinence. Although it is unusual, a sling eroding the urethra is a diagnosis that needs to be considered even 10 years after surgery. Endoscopic management is feasible and can be successful.     

两种入路尿道中段悬吊术治疗女性压力性尿失禁的临床效果比较

目的 比较经耻骨后和闭孔入路经阴道尿道中段无张力悬吊术治疗女性压力性尿失禁的临床效果和并发症.方法 应用经阴道尿道中段无张力悬吊术治疗女性压力性尿失禁患者134例,根据手术入路的不同分为两组:耻骨后组(32例)和闭孔组(102例).对两组的手术时间、失血量、治愈率和有效率以及术后并发症进行比较.结果 耻骨后组和闭孔组的手术时间分别为(24±6)min和(22±5)min,术中失血量分别为(45±27)ml和(54±23)ml,治愈率分别为81.25%和78.43%,有效率分别为96.88%和98.04%,两组比较差异无统计学意义(P＞0.05).两组术后并发症的发生率分别为:新发尿急6.25%和5.88%,排尿困难:3.13%和2.94%,膀胱损伤:3.13%和0%,阴道损伤:0%和2.94%,两组比较差异无统计学意义(P＞0.05).术后腹股沟疼痛的发生率分别为3.13%和20.59%,两者差异有统计学意义(P＜0.05).结论 耻骨后入路和闭孔入路尿道中段悬吊术均是治疗女性SUI的有效术式.     

Orthodontic extrusion of Ellis Class VIII fracture of maxillary lateral incisor – The sling shot method

The aim of this paper is to evaluate the efficacy of forced extrusion using the sling shot elastic. A 21?year adult patient reported with an Ellis Class VIII fracture of the maxillary right lateral incisor. Root canal treatment followed by a fiber reinforced composite post was placed and core build up was done. A metal button was bonded to the tooth. Begg brackets were placed from the second premolar on one side to the second premolar on the opposite side. 0.016″?×?0.025″ stainless steel was placed in ribbon mode. The ligature wire was placed as a sling shot from the button on the fractured tooth to the two adjacent teeth. 4?mm of extrusion was achieved and there was no evidence of root resorption. Forced extrusion was achieved in four months. The sling shot method is a very effective method of ligation. Light forces are delivered over a long duration with definitive results as compared to the inconsistent force delivery with conventional extrusion mechanics.