女性压力性尿失禁经耻骨上膀胱尿道悬吊术后并发症的防治

目的 探讨经耻骨上膀胱尿道悬吊术(SPARC)治疗女性压力性尿失禁术后并发症的防治.方法 2002年7月～2006年1月,采用SPARC治疗女性压力性尿失禁18例,年龄35～68岁,平均49岁.病程2～19年,平均8年.轻度6例,中度8例,重度4例.结果 手术时间25～50min,平均35min.出血量15～40ml,平均30ml.住院3～14d,平均5d.术中膀胱穿孔1例,经留置导尿管2周后治愈.1例术后排尿困难及尿潴留,在门诊行尿道扩张8次后治愈.1例术后3年出现吊带穿破膀胱及膀胱结石形成,经腔镜下膀胱结石碎石后行开放手术将膀胱内吊带切除.余17例随访3～6个月,2例增加腹压时轻度尿失禁,其余15例均排尿通畅,无漏尿及其他并发症.结论 SPARC术中术后注意细心操作和正确及时处理,可以有效降低术后并发症的发生率.     

耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁（附15例报告）

目的探讨耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁的疗效。方法应用耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁15例。结果随访6个月～3年，15例中12例治愈，1例Ⅱ型者部分有效，2例Ⅲ型者无效。2例术后发生尿潴留。尿道扩张后治愈。结论耻骨后经阴道膀胱颈悬吊术式是治疗女性压力性尿失禁的一种理想方法。     

Stamey膀胱颈悬吊术治疗女性压力性尿失禁远期疗效观察

目的　评价Stamey膀胱颈悬吊术治疗女性压力性尿失禁的远期疗效。　方法　 5 2例接受Stamey手术患者 ,平均年龄 46岁 ,平均尿失禁 7.5年 ,Ⅰ°尿失禁 18例、Ⅱ°2 1例、Ⅲ°13例。　结果　 1994年以前手术 3 2例因并发症失败 3例 ,随访 3 .6年时治愈率 87.5 %、改善率 6.2 %、失败率 6.2 % ,随访 9.6年时治愈率 68.8%、改善率 9.3 %、失败率 2 1.9% ;1994年以后手术 2 0例随访 4.3年 ,治愈率 90 .0 %、改善率 10 .0 % ,无失败病例。　结论　Stamey手术治疗压力性尿失禁疗效随时间延长而下降 ,术前准确区分尿失禁类型和发病机制、降低并发症是提高疗效的关键     

经阴道无张力尿道中段悬吊术治疗女性压力性尿失禁

2002年6月至2004年9月，我们采用经阴道无张力尿道中段悬吊术(TVT法)，治疗女性压力性尿失禁20例，疗效满意。现报告如下。     

经耻骨上膀胱尿道悬吊带治疗女性压力性尿失禁(附8例报告)

目的:探讨尿道悬吊带(SPARC)治疗女性压力性尿失禁的疗效.方法:局麻下对8例女性压力性尿失禁患者施行经耻骨上膀胱尿道悬吊带手术治疗.结果:平均手术时间45 min(30～70 min),平均住院2天(1～3天).术后留置导尿管24 h.8例患者术后尿失禁症状均消失,无并发症.结论:SPARC尿道悬吊带治疗女性压力性尿失禁疗效确切,操作简便,对患者损伤少,并发症发生率低,是一种治疗女性压力性尿失禁的有效方法.     

Raz术式治疗女性压力性尿失禁(附13例报告)

目的：探讨Raz术治疗女性压力性尿失禁的疗效。方法：应用经阴道膀胱颈悬吊术的Raz术式治疗女性压力性尿失禁13例。结果：随访6个月－3年，13例中10例治愈，1例Ⅱ型者部分有效，2例Ⅲ型者无效。无明显手术并发症。结论：Raz术式是治疗女性压力性尿失禁的一种理想方法。     

经阴道无张力性尿道中段悬吊术治疗女性压力性尿失禁10例分析

目的：探讨经阴道无张力性尿道中段悬吊术(TVT)在治疗女性压力性尿失禁中的意义。方法：10例患者，年龄45—58岁，平均48．4岁。临床表现为用力、咳嗽等时尿液不自主流出。病史4个月-15年。经详细地尿动力学检查证实为压力性尿失禁。行腹压漏尿点压(abdominal leak-point pressure，ALPP)测定，按照McGuire的方法分型，ALPP＞9．81kPa(I型)2例，ALPP6．38—9．81kPa(Ⅱ型)3例，ALPP＜6．38kPa(Ⅲ型)5例。结果：术后10例均无尿失禁，8例患者拔除导尿管当日即可顺利排尿，1例出现尿潴留，1例膀胱穿孔。结论：TVT手术安全易行，手术时间短，创伤小，患者康复快，治疗压力性尿失禁近期效果确切，远期疗效有待进一步研究。     

应用吊带方法经皮膀胱颈悬吊治疗女性压力性尿失禁

目的：介绍吊带方法经皮膀胱颈悬吊术治疗女性压力性尿失禁的经验。方法：在近膀胱颈水平，阴道前壁与尿道之间隧道状切口内预置两端带有尼龙线的网状聚丙烯片，术中窥镜监视下，应用Vesica穿刺针经皮穿刺行膀胱颈悬吊治疗女性压力性尿失禁19例。结果：随访3－45个月，平均17个月，除1例逼尿肌反射低下排尿稍费力外，18例患者无尿失禁及排尿困难。结论：吊带方法经皮膀胱颈悬吊术治疗女性压力性尿失禁，操作简便，创伤小，恢复快，临床效果满意。     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的探讨经闭孔无张力尿道中段悬吊术(trans-obturator tension free vaginal tape,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的临床疗效。方法2006年1月~2007年9月,对15例SUI行TVT-O,取阴道前壁纵行切口1cm,组织剪分离尿道旁阴道黏膜下间隙至闭孔膜,放入蝶形导引杆,将螺旋形穿刺针沿导引杆紧贴耻骨下支穿过闭孔膜,从大腿根部皮肤穿出,将吊带无张力放置于尿道中段下方。结果手术时间15~40min,平均30min。术中出血量10~40ml,平均20ml。术中无并发症。1例术后尿潴留,留置尿管5d后缓解。10例术后大腿根部疼痛,术后3~10d消失。15例随访2~19个月,平均8个月,均治愈,无复发。结论TVT-O操作简单、安全有效。     

无张力阴道悬吊术治疗压力性尿失禁(附8例报告)

无张力阴道悬吊术(tension-frcev aginaltape，TVT)是目前治疗女性压力性尿失禁的一种新方法，具有手术创伤小、手术时间短、患恢复快等优点。我们从2002年10月至2003年12月采用TVT方法治疗女性压力性尿失禁8例，疗效满意．现报告如下。     

One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence

AIM: To evaluate the safety and efficacy of the SPARC sling in women with urinary incontinence. METHODS: Women who presented with urinary incontinence symptoms were included in this prospective study. In total, 103 women underwent evaluation of subjective and objective cure rates, quality of life and urodynamic parameters following the SPARC procedure. RESULTS: The objective cure rate, defined as a pad weight test less than 1 g and negative cough stress test, was 84.4% at 12 months. Subjective cure rates, defined as no usage of pads/no urine loss during daily activities, were also encouraging: 75.0% at 12 months. Quality of life evaluation included asking patients to rate the amount of bother caused by their incontinence symptoms on a scale from 0 to 100. Preoperatively, the average was 76.7, dropping to 15.9 at 12 months. At 6 months, 93.7% (75/79) were 'very satisfied' and 5.1% (4/79) were 'satisfied;' one patient was 'dissatisfied' (1.2%, 1/79). Seventy-eight of 79 patients (98.7%) would recommend the procedure to a friend and undergo the procedure again. Patients returned to inside work an average of 1.4 days and to outside work 5.4 days after the procedure. The maximum flow rate decreased from a mean of 43.4 mL/s preoperatively to 37.08 mL/s at 12 months postoperatively (P = 0.049). Detrusor pressure at maximum flow and maximal urethral closure at rest increased from 16.94 and 50.85 cmH(2)O preoperatively to 21.69 and 60.61 cmH(2)O at 12 months, respectively (P = 0.015; P < 0.001). There were few postoperative complications, with no reported infections, erosions or hematomas. CONCLUSIONS: This prospective study demonstrates that the SPARC suprapubic sling is a safe and effective treatment for female stress urinary incontinence. Both objective and subjective measures of success were achieved, with low complication rates. Quality of life and urodynamic parameters were improved. The SPARC method provides safe and highly effective treatment for female stress urinary incontinence at one year.     

Management of polypropylene mesh erosion after intravaginal midurethral sling operation for female stress urinary incontinence

The intravaginal midurethral sling operations have become a trend to treat female stress urinary incontinence. Cases of complications requiring surgical revision are rarely reported. We report on seven patients with complications necessitating surgery. Six patients with vaginal erosion were treated with transvaginal excision of migrated tape and fibrotic tissues around the vaginal wall, and one patient with bladder erosion was treated with suprapubic minimal laparotomy and transvaginal partial excision of the tension-free vaginal tape (TVT). The incidence of polypropylene mesh erosion was 1.1% in this study. All patients recovered well from our surgical intervention, except the bladder erosion patient who needed anticholinergic medication to treat postoperative urgency and urge incontinence.     

The investigation of female stress incontinence

Genuine stress incontinence is a common problem whose pathogenesis stems from a disturbance of the normal anatomy and innervation of the bladder neck and proximal urethra. A thorough understanding of this, as well as a methodical and logical investigation of the problem, will ensure correct patient selection and achieve a good long-term cure. The authors present a discussion of stress incontinence and its investigation.     

Leakpoint pressures in female stress urinary incontinence

Patient selection is critical to achieving good results in the surgical management of stress urinary incontinence. The evaluation of urethral function in these women is of great importance, since the choice of operative technique often depends on the ability of the urethra to generate adequate resistance to the explusive forces of increased abdominal pressure. The Valsalva leakpoint pressure (VLPP) has been described as an easily performed, reproducible and accurate urodynamic test to assess the patient for the presence of intrinsic sphincter deficiency (ISD). Critical review of the VLPP demonstrates its reproducibility and correlation with other measures of ISD. However, more work needs to be done to identify the truly critical values of VLPP that would help in selecting the most appropriate procedure in surgery for stress incontinence.     

Magnetic resonance imaging in female stress incontinence

A new technique is described for determination of the anatomy of the urethrovesical junction using magnetic resonance imaging. Using this technique it is possible to precisely define the anatomical relationships of the urethra and bladder base within the pelvis. It is non-invasive and non-ionizing. This report demonstrates its usefulness in Urogynecology.     

The contemporary clinical treatment of female stress incontinence

Genuine stress incontinence is a common problem whose pathogenesis stems from an anatomical defect of the bladder neck and proximal urethra. After correct investigation treatment can be instigated which will ensure a successful outcome. Contemporary management is reviewed.     

Healthcare utilization among women who undergo surgery for stress urinary incontinence

Abstract This study examined patterns of care for women undergoing surgery for stress urinary incontinence (SUI). A retrospective analysis of administrative claims data was performed and we identified 12,520 women with a diagnosis of SUI and a subset of 3,735 women with a surgical procedure code for SUI. For the main types of surgeries, we examined length of stay, pharmaceutical use, complications, and healthcare utilization related to incontinence greater than 6 months after surgery. Approximately 30% of women with a coded SUI diagnosis underwent surgery. Of the initial procedures, 40% were retropubic suspensions and 25% were sling procedures. Almost 4% of women underwent an additional surgery, and 14.1% had claims related to incontinence 6 or more months after the initial procedure. We examined medical care and pharmaceutical use for women undergoing continence surgery. This information may be important to patients and physicians discussing treatment options. Editorial Comment: This study attempts to examine patterns of care for women undergoing surgery for stress incontinence. The authors used a large healthcare claims database to obtain their data. The limitation of the study is that their data is limited to the diagnostic and treatment codes that were marked. However, the study does provide important information on the medical care and pharmaceutical use patterns of women who undergo surgery for stress urinary incontinence and extends our understanding of post-surgical outpatient utilization     

Vesica经皮膀胱颈悬吊治疗女性压力性尿失禁

目的　介绍Ｖｅｓｉｃａ 经皮膀胱颈悬吊术治疗女性压力性尿失禁的手术方法。　方法　应用此术式治疗５ 例患者，通过特制器械将阴道前壁做Ｚ形悬吊，固定于耻骨，使悬吊有一稳定支持，悬吊面积宽阔，悬吊线张力固定。　结果　５ 例患者术后尿垫实验阴性。平均随诊２５ ．２ 个月，５ 例均无尿失禁。　结论　该术式临床效果满意，创伤小，恢复快，悬吊稳定可靠     

The use of digital videoradiography by image subtraction in the study of female stress incontinence

The authors describe this new videocystourethrography technique which differs from traditional radiographic analysis in its image acquisition system. These radiographic images are first recorded by the image intensifier of a videofluoroscopic system; they are then digitalized, stored, and processed by a computer. They are eventually retranslated into analogical images for the study of female stress incontinence.     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。