经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁85例

 目前,经阴道无张力尿道中段吊带术(tension-freevaginal tape,TVT)是治疗压力性尿失禁最常采用的方式,具有创伤小,效果确切等优点。但是,传统的耻骨后TVT易发生膀胱穿孔、尿道损伤,耻骨后血肿形成等手术并发症 ^[1,2]。经闭孔无张力尿道中段吊带术(tension-free vaginal tape obturator, TVT-0)是在TVT手术基础上改进的一种手术方式^[3],由于术中没有经过耻骨后路径,所以大大降低了盆腔脏器损伤和大血管损伤的危险。我科2008-01-01至2013-12-31采用该术式治疗压力性尿失禁(stress urinary incontinence,SUI)85例,效果满意。     

女性压力性尿失禁的微创治疗

目的探讨治疗女性压力性尿失禁的微创手术方法。方法对48例女性压力性尿失禁患者（其中尿失禁Ⅰ级15例,Ⅱ级20例,Ⅲ级13例）应用经闭孔无张力尿道吊带术（TensionFreeObturatorTape,TOT）治疗,对治疗结果进行分析。结果手术时间平均（30±5）min;术中出血量平均（30±10）ml。术后患者随访2．4年,均治愈,无失败病例。结论TOT等微创手术治疗女性压力性尿失禁安全、微创、效果满意。     

经尿道钬激光切除膀胱尿道侵蚀尿失禁吊带的疗效观察

正目的:本研究拟观察经尿道钬激光切除膀胱尿道侵蚀吊带的疗效,为更好处理尿失禁吊带侵蚀这一并发症提供依据。方法:回顾分析2013年1月至2015年12月,尿道中段悬吊术后尿道或膀胱吊带侵蚀患者6例的临床资料,年龄55~72岁,平均65岁。2例原手术采用TOT术式,4例采用TVT术式,尿道侵蚀1例,膀胱侵蚀5例。采用经尿道钬激     

尿道悬吊术治疗女性压力性尿失禁41例

目前 ,对女性压力性尿失禁常采用耻骨后尿道悬吊术、阴道前后壁修补术和针刺线吊术等 ,但有远期复发率较高和术后有排尿困难等缺点[1] 。 1999年 11月以来 ,我院采用无张力阴道吊带 (tension freevaginaltape ,TVT)手术治疗 4 1例 ,疗效良好。1　临床资料1 1　一般情况　 4 1例中 ,年龄 33～ 84岁 ,平均 6 4岁。病程 2～ 37年。单纯性压力性尿失禁 2 3例 ,混合性尿失禁 18例。1 2　方法1 2 1　手术材料　一次性TVT装置 ,由中国强生医疗有限公司 (johnson& johnsonmedicalchina)提供 ,大小为 1 1cm× 4 5cm、厚 0 7cm聚丙烯网带(polypro…     

经阴道尿道无张力吊带术治疗女性压力性尿失禁(附40例报告)

目的　回顾性分析新的治疗压力性尿失禁的微创方法———经阴道尿道无张力吊带 (TVT)术的有效性与安全性。方法　对40例患者于阴道前壁距尿道外口 1 0cm处将阴道黏膜纵形切开 1 5cm后置入吊带。结果　 34例完全治愈 ,无尿潴留、无尿失禁 ;2例术后 2周内、1例术后 3个月后出现轻度尿潴留 ,经尿道扩张后均消失 ;2例术后尿失禁显著减轻 ;4例术中出现膀胱穿孔 ;1例术后出现大片阴道黏膜脱落 ,后自愈 ;1例术后 5天出现急性大面积心肌梗死死亡。结论　TVT术作为治疗女性压力性尿失禁的新的微创手段具有创伤小、痛苦少、效果好、并发症轻微、安全性高的优点 ,值得推广应用。     

无张力性阴道吊带治疗压力性尿失禁26例

女性压力性尿失禁是临床常见疾病,既往多种术式疗效不佳,经阴道无张力尿道中段吊带（Tension-free vaginal tape,TVT）技术因疗效肯定、方法简便、损伤小、住院时间短,成为近年治疗女性压力性尿失禁（Stress urinary incontinence．SUI）的新方法,2003年1月-2005年7月笔者用此方法治疗女性压力性尿失禁26例,疗效满意。     

应用阴道无张力尿道中段悬吊术治疗压力性尿失禁患者的护理

压力性尿失禁（stressurinaryincontinence,SUI）是指在平时无遗尿现象,而当咳嗽、喷嚏、大笑或作重体力劳动等腹压突然增高时发生遗尿。压力性尿失禁严重影响患者的生活质量。经阴道无张力尿道中段悬吊术（tension—freevaginaltape,TVT）只有3个小切口,经腹膜外路径下完成穿针操作,仅在患者下腹部切2个1cm的切口,将一种特制的人造纤维悬吊带无张力式地置放在尿道中下方,     

同期行经尿道前列腺电切术与无张力疝修补术治疗体会

目的探讨前列腺增生症合并腹股沟疝患者同期行前列腺电切术及腹股沟疝无张力修补术的可行性及效果。方法36例患者均采用连续硬膜外麻醉,先取截石位以手枪式STORZ电切镜行经尿道前列腺电切术,术毕留置三腔尿管,予持续膀胱冲洗,再改平卧位取腹股沟斜切口行平片无张力疝修补术。结果术后随访6～36月,排尿通畅,最大尿流率14～25ml/s,平均19.6ml/s,无尿失禁,疝无复发。结论同期行电切术及无张力疝修补术可达分期手术效果,具有减少麻醉、手术次数及手术风险,减轻患者痛苦,减少住院时间及住院费用的优点。     

经尿道钬激光前列腺剜除术患者的临床护理要点分析

目的 研究分析经尿道钬激光前列腺剜除术患者的临床护理要点以及效果.方法 择取实验对象共38例,均为行经尿道钬激光前列腺剜除术患者,结合患者基本情况,按照手术要求施予相应的护理,观察分析护理效果.结果 38例实施经尿道钬激光前列腺剜除术患者,术中出血量在52-189 mL之间,平均出血量为89.23±4.35 mL,手术时间35-118 min,平均手术时间为72.31±4.33 min.有2例患者由于术后出血而进行膀胱冲洗,剩余患者均在术后2-3天拔除导尿管,于3-6天出院.38例患者对本次护理均满意.结论 对行经尿道钬激光前列腺剜除术患者,加强整个围手术期的护理,有利于手术顺利进行,预防和减少并发症的发生,促进患者尽快康复.     

经尿道钬激光治疗非肌层浸润性膀胱肿瘤

正目的:评价经尿道钬激光膀胱肿瘤切除术治疗浅表性膀胱肿瘤的临床疗效及安全性。方法:对2012年1月至2014年12月,诊断为非肌层浸润性膀胱肿瘤的患者32例,行经尿道钬激光膀胱肿瘤切除,其中24例为初发,8例为复发。并对患者的临床资料进行回顾性分析。结果:32例膀胱肿瘤均一次手术成功,手术时间20~60min,平均36 min,术中无闭孔神经反射,无膀胱穿孔及明显出血等严重并发症发生,术后保留导尿3~6 d,平均4.6 d。     

Novel surgical procedure for the treatment of female stress urinary incontinence by using transobturator vaginal tape

INTRODUCTION/AIM: Current method in the treatment of female urinary incontinence implies the placement of tension-free suburethral vaginal tape, using a retropubic or transobturator approach. Considering numerous complications related to retropubic approach, we reported the results of transobturator procedure in prospective study. METHODS: We used a non-absorbable polypropylene tape with the outside-in (Herniamesh) or in-outside (Johnson & Johnson) transobturator approach. RESULTS: During the period from October 2004 to September 2005 the procedure was carried out in 10 patients. In only 2 cases urinary stress incontinence occured as isolated problem managed with transoburator tape, whereas in 8 patients this procedure was associated with other operative gynecologic events. No perioperative complication was encountered. In 80% of the patients a satisfactory result was obtained, while one patient failed to demonstrate any amelioration, and the other developed subsequently urge incontinence. CONCLUSION: Transobturator tesion-free vaginal tape represents a very simple, safe and, in the large percent of cases, successful procedure in the management of urinary stress incontinence, with rare perioperative complications.     

盆底重建术治疗盆腔脏器脱垂的临床分析

目的探讨盆腔器官脱垂(POP)患者运用盆底修复网片系统进行盆底重建治疗的疗效。方法选择Ⅲ度及以上子宫或(和)阴道壁脱垂患者32例,24例行全盆重建术(75.0%),8例行前盆重建术(25.0%),10例合并压力性尿失禁同时行TVT-O尿道中段悬吊术(31.3%)。结果 32例患者手术过程均较顺利,术中无严重并发症。术后随访2～4年,除1例(3.13%)子宫、阴道前壁轻度膨出外,余无复发,另有1例患者术后足月孕剖宫产一子,产后未发现POP复发迹象。术后性生活困难、急迫性尿失禁、网片侵蚀的发生几率分别为21.43%,6.25%和0。结论用盆底修复网片系统进行盆底重建治疗POP是一种安全、有效、微创的术式,中短期疗效满意。     

阴道骶韧带悬吊术预防子宫全切术后盆底功能障碍的效果评价

 目的 评价骶韧带悬吊术在预防腹式子宫全切术后盆底功能障碍的效果。方法 选择2012-01至2013-06住院的符合子宫全切术指征的良性疾病且子宫体积≥12孕周患者84例,随机分为两组,每组42例。单纯组为单纯腹式子宫全切术,联合组为腹式子宫全切术加骶韧带悬吊术。比较术后6、12个月阴道长度以及脏器脱垂及其程度、压力性尿失禁等情况。结果 术后6、12个月联合组阴道长度分别为(7.72±1.76)cm、(8.13±1.46)cm,均长于单纯组(6.91±1.40)cm、(6.74±1.74)cm。术后12个月联合组发生压力性尿失禁者1例,单纯组8例,两组存在统计学差异(P=0.029)。术后12个月联合组患者发生膀胱膨出者2例,单纯组9例,两组存在统计学差异(P=0.048)。结论 阴道骶韧带悬吊术可预防腹式子宫全切术后的盆底功能障碍。     

Reliability of voiding colpo-cysto-urethrography in female urinary stress incontinence before and after treatment

Voiding colpo-cysto-urethrography was performed in 52 consecutive female patients with genuine urinary stress incontinence before treatment and in 50 of the patients after treatment. The patients were randomized to either pelvic floor training or surgery. Surgery included a colposuspension operation in patients with an anterior suspension defect and a vaginal repair in patients with a posterior suspension defect. All pre- and posttreatment examinations were reevaluated blindly by one observer 4 to 6 years later. The pretreatment radiologic reevaluation was in agreement with the original classification in 79 per cent and not in agreement in 21 per cent. Pelvic floor training did not change the degree of suspension defect systematically. The effect of squeezing was significantly improved following pelvic floor training. A colposuspension gave rise to a typical radiologic configuration of the bladder and urethra. A vaginal repair was not detectable radiologically and it did not correct a posterior descent. The degree of descent and the degree of incontinence were not correlated and it was not possible radiologically to distinguish treatment failures from treatment success.     

Urinary incontinence, pelvic floor dysfunction, exercise and sport

Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes than in other women. There is a need for more basic research on pelvic floor muscle function during physical activity and the effect of pelvic floor muscle training in female elite athletes.     

Adherence to pelvic floor muscle exercise and long-term effect on stress urinary incontinence A five-year follow-up study

The purpose of this investigation was to study adherence to exercise, pelvic floor muscle (PFM) function and strength and patient satisfaction 5 years after cessation of organized PFM exercise for stress urinary incontinence. All 23 women who had taken part in an "intensive exercise group" in a randomized trial 5 years ago participated in the follow-up study. Structured interview, vaginal palpation and vaginal squeeze pressure were used to assess the condition, PFM function and muscle strength, respectively. Seventy percent of the women were exercising the PFM once a week or more often. Two women were not able to correctly contract the PFM. Mean PFM strength was 18.1 cm H₂O. Three had undergone surgery since the initial study. Sixty-one percent were satisfied with their condition.     

Urinary continence in women during centrifuge exposure to high +Gz

BACKGROUND: One earlier study and anecdotal evidence suggest a possible association between exposure to high +Gz forces and urinary incontinence in women. High +Gz could possibly contributes to the prolapse of the bladder neck, moving it into a position which decreases the leak point pressure resulting in urinary incontinence. HYPOTHESIS: We tested the hypothesis that increased urinary incontinence is associated with high +Gz. METHODS: 25 females were exposed to a high +Gz profile. Following the exposure they were asked to answer a questionnaire grading their urinary continence under high +Gz, and to provide a baseline grading of their urinary continence at +1.0 Gz and under increased abdominal stress at +1.0 Gz. Demographic data included parity and previous urogenital surgery. Graded responses were dichotomized and data was analyzed using Fischer's Exact Test for 2x2 tables with significance set at alpha = 0.05. RESULTS: At high +Gz no significant association was found between reported urine incontinence and a history of urogenital surgery or parity. Only one of twenty-five subjects had any symptoms at high +Gz despite the fact that five had a predisposition. As expected, at +1.0 Gz and under increased abdominal stress at +1.0 Gz a significant association was found between reported urine incontinence and a history of urogenital surgery, while no significant association was found for parity. CONCLUSIONS: In this simple first look there was no increase in urinary incontinence at high +Gz even among those who reported a predisposition.     

Magnetic resonance imaging for stress incontinence: evaluation of patients before and after surgical correction

OBJECTIVE: The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in the pre and postoperative assessment of stress urinary incontinence. METHODS: Fifteen female patients with clinical evidence of stress urinary incontinence were included in this prospective study. All the patients underwent MRI in the supine position both preoperatively and postoperatively. For imaging, we used a 1.0 T magnet, T2-weighted images were obtained in the midline sagittal plane with patients at rest. Images were evaluated for anatomical stress urinary incontinence alterations, such as the increased distance between the pubococcygeal line and the bladder base and the posterior urethro-vesical angle and the urethral inclination angle changes. Wilcoxon signed rank test allowed comparisons of pre and postoperative results. RESULTS: Compared with postoperative measurements, the bladder base was lowered significantly by an average of 9.4+/-4.0 mm (P<0.01), posterior urethro-vesical angle was significantly increased by an average of 127.8+/-11.4 degrees (P<0.01), and the urethral inclination angle was significantly increased by an average of 54.9+/-10.1 degrees (P<0.01) preoperatively. CONCLUSION: Our results suggest that MRI can play a major role in the preoperative and postoperative assessment of stress urinary incontinence. It can reliably detect anatomical urinary incontinence alterations. MRI should be considered in failed surgery, complex prolapse, and in differentiating genuine stress incontinence resulting from malposition of the bladder neck from stress incontinence due to intrinsic urethral damage.