经闭孔尿道中段吊带术治疗女性压力性尿失禁的疗效分析

目的:探讨女性压力性尿失禁(SUI)的临床特征及经闭孔尿道中段吊带术(TVT-O)治疗SUI的疗效。方法:回顾性分析2009年10月至2018年6月海军军医大学第一附属医院收治的319例女性SUI患者的病例资料。中位年龄58(39~91)岁,其中≥60岁145例(45.5%)。伴高血压病96例(30.1%),糖尿病24例(7.5%)。未婚未孕2例(0.6%),有生育史317例(99.4%)。31例(9.7%)合并Ⅱ~Ⅳ度盆腔脏器脱垂。SUI中位病程5(0.2~40.0)年。中度尿失禁155例(48.6%),重度尿失禁164例(51.4%)。319例术前中位最大尿流率30(5.2~72.6)ml/s,中位尿流量380.5(56.7~1013.6)ml。术前国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)中位评分14(9~19)分。288例行TVT-O。31例合并Ⅱ~Ⅳ度盆腔脏器脱垂者,一期行经闭孔四臂网片盆底修复术联合TVT-O。结果:288例TVT-O平均手术时间(32.3±8.0)(19~60)min,31例盆腔修复手术联合TVT-O平均手术时间(75.5±17.0)(50~120)min。术后随访265例,随访率83.1%,随访时间12~24个月。其中254例(95.8%)客观治愈,248例(93.6%)主观治愈,10例(3.8%)主观缓解,7例(2.6%)主观无改善。30例(96.8%)盆腔脏器脱垂治愈。术后并发症分别为腹股沟区疼痛28例(10.6%),新发尿急12例(4.5%),尿路感染9例(3.4%),排尿困难7例(2.6%),性交痛3例(1.1%),膀胱损伤、吊带侵蚀、切口瘢痕增生各1例(0.4%)。结论:女性SUI患者以中老年为主,就诊时以中重度患者为主。TVT-O治愈率高、并发症较少且大多在可控范围内。对于SUI合并中重度盆腔脏器脱垂患者,可一期行TVT-O联合盆底修复手术。

Retrospective analysis clinical characteristics of female stress urinary incontinence and efficacy of transobturator tension-free vaginal tape procedure

Objective To explore the clinical characteristics of patients with female stress urinary incontinence(SUI)and efficacy of Transobturator Tension-free vaginal tape procedure.Methods We retrospectively analyzed the clinical data of 319 cases who were operated transobturator tension free vaginal tape in Shanghai Changhai Hospital Affiliated of Naval Medical University from Oct.2009 to Jun.2018.Patients age ranged from 39 to 91 years old,with the average age of(59.2±9.7)years old.145(45.5%)patients aged≥60 years old.Among them,155(48.6%)patients with moderate SUI,164(51.4%)with severe SUI.96 cases(30.1%)hypertension,24(7.5%)diabetes,2(0.6%)had not given birth,317(99.4%)patients had given birth more than once.31(9.7%)coexisting pelvic organ prolapse with POP-Q stage 2 and above.Maximum urinary flow rate ranged 5.2-72.6 ml/s.Cystometric capacity ranged 56.7-1013.6 ml.Average preoperative ICIQ-SF score was 13.9(range 9-19).Results Operative time of 288 TVT-O procedures ranged 19-60 min,and 31 cases in the surgical management of cystocele with concomitant ranged 50-120 min.A total of 265 patients were evaluable followed up for 12-24 months,Objective cure rate and subjective cure rate were achieved in 95.8%(254 cases)and 93.6%(248 cases)respectively.POP was cured in 96.8%patients.Postoperative complications were 10.6%groin pain,4.5%urgency,others including urinary tract infection(3.4%),de novo dysuresia(2.6%),dyspareunia(1.1%),and one case of bladder injury,one case sling erosion and one case scar hyperplasia.Conclusions Female stress urinary incontinence were mainly in middle-aged and elderly people who had severely psychological quality of life lasting for several years.TVT-O may achieve a high success or improvement rate and no serious adverse effects.One operation could correct the stress urinary incontinence and simultaneously correct prolapse.