自制吊带经闭孔尿道中段悬吊术治疗压力性尿失禁疗效观察

目的:观察自制吊带行改良经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床效果。方法:50例中、重度压力性尿失禁患者采用聚丙烯网片自制吊带行改良经闭孔无张力吊带尿道中段悬吊术,观察手术情况及术后效果。结果:50例患者手术均成功。平均手术时间11.5±10.1min,术中平均出血量19.9±14.4ml;平均住院7.5±3.3d;无手术并发症发生。随访6-36个月,47例完全治愈,3例有效,有效率100%。无远期并发症,无复发病例。结论:聚丙烯网片自制吊带尿道悬吊术治疗压力性尿失禁疗效确切。     

两种悬吊术治疗女性压力性尿失禁疗效比较

目的探讨经闭孔尿道中段无张力悬吊术和改良尿道中段无张力悬吊术在治疗女性压力性尿失禁中的疗效。方法 2008年5月至2009年5月在南京医科大学附属常州市第二人民医院将100例压力性尿失禁患者随机分成两组,一组进行经闭孔尿道中段无张力悬吊术,简称闭孔组,作为对照组;另一组行改良尿道中段无张力悬吊术,简称改良组;比较两组术中情况及术后疗效。结果分别对两种方法的手术时间,术中出血量,排气时间及住院时间等指标进行统计学分析(P<0.05),结果表明改良组较对照组手术时间短,术中出血少,住院时间短(P<0.05);而改良组在术后1年的复发率较对照组差异无统计学意义(P>0.05)。结论改良尿道中段无张力悬吊术手术更简单,短期疗效满意,对患者生存质量有很大改善,但对其长期疗效还有待进一步研究。     

经耻骨后与经闭孔无张力尿道悬吊术治疗女性压力性尿失禁并发症分析

目的比较经耻骨后无张力尿道悬吊术（TVT）和经闭孔无张力尿道悬吊术（TVT—O）治疗女性压力性尿失禁的手术并发症。方法回顾性分析我院2002年9月-2007年6月应用TVT和TVT—O治疗女性压力性尿失禁患者167例（TVT术74例,TVT-O术93例）的临床资料。结果术中膀胱穿孔：TVT组发生率为9．46％,TVT—O组为1．08％（P〈0．05）;术中出血〉100ml：TVT组发生率为16．22％,TVT—O组6．45％（P〈0．05）,其他术中、术后并发症发生率两种手术方法比较,差异无显著性（P〉0．05）。结论与TVT比较,TVT-O手术并发症的发生率低,且手术操作简便、手术时间短,是一种较理想的治疗女性压力性尿失禁的手术方法。     

经闭孔无张力尿道中段悬吊术及其临床应用

女性压力性尿失禁（SUI）是一种常见病，也是一个社会和卫生问题。SUI手术的目的是让患者完全恢复尿控．而同时又要避免发生严重并发症。在过去20年中SUI的病理概念不断得到发展，多种致力于治疗SUI的外科技术不断得到发展。SUI手术治疗新型术式——经闭孔无张力尿道中段悬吊术安全，快捷，可靠，手术时间短，手术创伤小，治愈率高，并发症少，目前已被多家大中医院所采用，有广阔的应用前景，但其作为一种新型的微创手术，其长期疗效国内外尚无相关报道，有待临床实践验证。其手术特点及临床疗效现综述如下。     

阴道无张力尿道中段悬吊术治疗压力性尿失禁临床效果分析

目的　探讨阴道无张力尿道中段悬吊术(TVT)治疗女性压力性尿失禁的临床结局。方法　2001年 1月至 2003年 12月北京协和医院对 60例经尿动力学证实为压力性尿失禁 (其中 4例为混合性尿失禁)同时伴有不同程度盆底器官膨出患者进行了TVT术及相关妇科手术,采用标准化前瞻、开放研究对术前、后进行评估。结果　单行TVT平均手术时间 27 52min,术中出血量平均为 26.12mL,平均住院天数 1 86d。未发生术中严重并发症, 16.7%患者发生尿潴留的近期并发症;患者年龄≥ 50岁组比 <50岁组易发生尿潴留 (P<0 01 ); 2例(3.3% )发生远期并发症;其他妇科手术与TVT术同时进行无术后病率的发生;以患者主观感觉评价,平均随诊12.38个月, 96.7%患者治愈, 3.3%主观改善明显,无一例无效,随访未见患者有复发的征兆。结论　TVT术是治疗女性压力性尿失禁的一种微创、安全和有效的手术方法。其他妇科手术与TVT术同时操作是可行的。     

经闭孔无张力尿道中段悬吊术及其临床应用

女性压力性尿失禁(SUI)是一种常见病,也是一个社会和卫生问题.SUI手术的目的是让患者完全恢复尿控,而同时又要避免发生严重并发症.在过去20年中SUI的病理概念不断得到发展,多种致力于治疗SUI的外科技术不断得到发展,SUI手术治疗新型术式--经闭孔无张力尿道中段悬吊术安全,快捷,可靠,手术时间短,手术创伤小,治愈率高,并发症少,目前已被多家大中医院所采用,有广阔的应用前景,但其作为一种新型的微创手术,其长期疗效国内外尚无相关报道,有待临床实践验证.其手术特点及临床疗效现如下.     

尿道折叠术联合尿道中段耻骨悬吊术在压力性尿失禁治疗中的应用

压力性尿失禁(stress urinary incontinence,SUI)是女性常见疾病,在中重度SUI的治疗中,手术治疗占有重要的地位.由于吊带相关并发症的发生,传统的尿失禁手术越来越受到关注.文章回顾了尿失禁手术治疗的方法,介绍了尿道折叠术联合尿道中段耻骨悬吊术在SUI手术治疗中的应用,并对手术的相关问题进行探...     

阴道无张力尿道中段悬吊术治疗压力性尿失禁34例临床分析

目的　评估阴道无张力尿道中段悬吊 (TVT)术治疗女性压力性尿失禁术后近 2年的疗效。方法　对 34例经尿动力学检查证实为压力性尿失禁同时伴有不同程度的阴道前壁膨出患者 ,行TVT术及阴道前壁修补术治疗 ,并对术后 2年内的效果进行随访。结果　 33例患者TVT手术均在局部麻醉加静脉麻醉下完成 ;平均手术时间 2 6 .9min ;术中出血量平均 2 9.8ml;30例 (88% )患者在术后 12h内自行排尿 ,残余尿 <10 0ml;另 4例 (12 % )患者术后需短暂保留尿管。平均住院 2 .9d ,30例 (88% )患者住院 2d以内 ;术后以患者主观感觉评价 ,平均随访 8.3个月 ,32例 (94 % )主观完全治愈 ,2例 (6 % )为明显改善 ,无一例无效 ;手术并发症少。结论　TVT术是治疗女性压力性尿失禁微创、有效和安全的手术方法之一     

自制网片经阴道无张力尿道中段悬吊治疗女性压力性尿失禁

<正>女性压力性尿失禁是中老年妇女的常见病,发病率为15%～30%,成年女性发生尿失禁达46.5%,其中,压力性尿失禁占59.6%。近年治疗压力性尿失禁的新方法不断出现,但疗效较好、并发症少、费用低的方法应推经阴道尿道中段补片悬吊术(童式前路悬吊术),此后童晓文教授对此术进行了改良,将原来网片缝于耻骨降支的骨膜改为经闭孔固定于耻骨降支。2005年12月至2006年12月我们应用此法治疗女性压力性尿失禁30例,现报道如下。     

合并其他阴式手术的经闭孔尿道中段悬吊术治疗压力性尿失禁的疗效分析

目的探讨合并其他阴式手术的经闭孔尿道中段悬吊术（TVT—O）治疗压力性尿失禁（SUI）的近期疗效和影响因素。方法选取2006年12月至2012年5月南京军区福州总院收治的SUI患者184例,根据是否合并其他阴式手术将其分为联合TVT—O组（57例）和TVT—O组（127例）。分析两组患者的围手术期并发症及术后1年的疗效,并采用泌尿生殖道疾病相关问卷-6（UDI-6）和尿失禁影响程度相关问卷-7（ⅡQ-7）评估患者术后的生活质量。结果联合TVT—O组患者术中出血量、手术时间和尿管留置时间分别为（80．52±53．68）ml、（65．37±33．12）min和（75．31±47．84）h;TVT～O组分别为（16．26±11．72）ml、（17．45±8．92）min和（23．69±11．11）h,两组比较,差异均有统计学意义（P均〈0．05）;联合TVT—O组并发症发生率（14．04％,8／57）与TVT-O组（11．02％,14／127）比较,差异无统计学意义（P〉0．05）;联合TVT-O组与TVT-O组随访时间分别为（36．82±22．34）个月和（38．30±25．75）个月,联合TVT—O组治愈率（94．74％,54／57）与TVT-O组（97．64％,124／127）比较,差异无统计学意义（P〉0．05）;术后1年联合TVT-0组UDI-6和IIQ-7评分分别为（0．72±0．70）分和（0．74±0．69）分,TVT-O组分别为（0．69±0．72）分和（0．71±0．71）分,均较术前降低（P〈0．05）,但两组间比较,差异无统计学意义（P〉O．05）。结论TVT—O合并其他阴式手术虽然延长了尿管留置及术后住院时间,但并不影响TVT—O治疗SUI的近期疗效。     

Comparison of two outside-in transobturator midurethral slings in the treatment of female urodynamic stress incontinence

ObjectiveTo explore the difference between two brands of outside-in transobturator midurethral sling (TOT) for urodynamic stress incontinence (USI).Materials and methodsWomen who underwent an outside-in TOT procedure by either Monarc or Obtryx were retrospectively reviewed. Data of women with available information at baseline and postoperative 12-month follow-up were analyzed. The analyzed data included standardized interview, pelvic examination, as well as sling location and sling tension explored by introital four-dimensional ultrasound. Sling position were explored through the distances between the sling center and the caudal margin of the pubic symphysis (SPd) as well as sling percentile (SP) along the urethral length as a percentage in the midsagittal plane. SPd was also used to explore sling tension. Clinical outcomes were compared between two groups. Sling location and sling tension were compared in success cases between two groups.ResultsThere were 138 women in Monarc group and 140 women in Obtryx group. Rates of stress urinary continence and adverse events were not statistically different after two TOT. SPd was similar between both procedures. Obtryx located more ventrally than Monarc, indicated by a smaller SP during resting (41.6% vs 58.5%, P < 0.001), straining (38.0% vs 54.4%, P < 0.001), and coughing (39.8% vs 48.8%, P < 0.001).ConclusionAt 12-month assessment, both outside-in TOT procedures were not significantly different in terms of clinical results and sling tension, while Obtryx sling located more ventrally than Monarc.     

A new,simple, safe,effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling

We developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US dollar 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.     

Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence

ObjectiveThe purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI).Materials and methodsEighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia.ResultsThe median follow-up period was 35 months (range, 12–50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group.ConclusionConcomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.     

Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence.

OBJECTIVE: To compare the cure rate and confirm the clinical efficacy of the 3 most frequently performed surgical procedures for stress urinary incontinence (SUI). METHODS: Between January 2001 and May 2003, 92 women with SUI were randomly assigned to undergo the Burch colposuspension (n=33), pubovaginal sling (n=28), or tension-free vaginal tape (n=31) at the Department of Obstetrics and Gynecology, Yonsei Medical Center, Seoul, Korea. Patient characteristics, urodynamic study results, cure rates at 3, 6, and 12 months, and complication rates were compared using the chi2 test. RESULTS: There were no statistically significant differences in the cure rates initially, but after 12 months the cure rate of the pubovaginal sling procedure was found to be significantly higher than those of the tension-free vaginal tape or Burch colposuspension procedures. CONCLUSION: The cure rate of the pubovaginal sling procedure was significantly higher after 1 year, but no difference in efficacy was observed between the 2 other procedures. A randomized prospective study of a larger population should be conducted.     

Midurethral Tissue Fixation System sling -- a 'micromethod' for cure of stress incontinence -- preliminary report

AIMS: To assess the effectiveness of the Tissue Fixation System (TFS) in patients with stress incontinence. The TFS uses two small plastic anchors to fix an (adjustable) midurethral polypropylene mesh sling into the soft tissues below the pubic bone. PATIENTS AND METHODS: Thirty-six patients with stress incontinence, mean age 55 (35-87), mean weight 76 kg (33-117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation. The patients were preoperatively assessed with a structured questionnaire, 24-h urinary diary, cough stress test, transperineal ultrasound, and urodynamics. Using the TFS delivery system, a midurethral mesh tape was attached to the fibromuscular tissues behind the perineal membrane. The suburethral vaginal fascia was also tightened. Post-operatively. the patients were reviewed at 6 weeks, and at 3-monthly intervals with ultrasound, and cough stress tests. RESULTS: Primary symptomatic cure rate at mean 9 months (3-15 months) was 83.4% (n = 36). Pad test loss decreased from a mean 12.7 g to a mean of 0.2 g; mean operating time was 5 min, and mean hospital stay was 24 h (12-48 h). There were no cases of obstructed micturition, and minimal analgesia only was required postoperatively. CONCLUSION: The TFS is a promising new method. The results at this stage are similar to those achieved previously with the 'tension-free' tape operations, but with greater safety and shorter operating time. Testing by other surgeons will be required to evaluate this method further.     

Evaluation of the efficacy and safety of single incision sling vs TVT-O in obese patients with stress urinary incontinence: Quality of life and sexual function analysis

ObjectivesThe aim of the study is to demonstrate the best stress urinary incontinence (SUI) surgical technique for women with a Body mass index higher than 30. The results of Transvaginal Tension Free Vaginal Tape-Obturator and Mini-sling surgery were analyzed and compared through both clinical examination and standardized questionnaires at 36 months of follow-up.Materials and methodsThis is a retrospective multicenter study over 159 women with SUI who underwent surgery. Seventy-eight women underwent TVT-O and 81 Mini-sling technique. Intra and post-operative complications were recorded. Patients were monitored for 36 months by analyzing symptoms, voiding diary, quality of life and sexual activity through standardized questionnaires.ResultsComplications had a low incidence in both groups and inter-group differences were superimposable. Only groin pain was statistically higher after TVT-O than after Mini-sling (12.8% vs1.2%, p = 0.03). At 36 months of follow-up, a statistically significant decrease in Positive stress test (%) and Q-Tip test (grade) was observed in both groups with no differences between them (p = 0.54 and p = 0.32 respectively). The mean number of daily voids was higher after TVT-O (p = 0.04) than after Altis (p = 0.22) with a significant difference in favor of the Altis group (p = 0.03). After 36 months, there were no significant differences between groups in terms of quality of life and sexual activity. PGI-I did not show any difference between groups (p = 0.21).ConclusionTVT-O and Minisling had the same efficacy and results in the surgical treatment of SUI in obese women. Both techniques relieved their symptoms and improved their quality of life without any significant difference except for a lower incidence of post- Mini-sling complications.     

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery

Objective

A midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients.

Comparison of retropubic and transobturator tension-free vaginal implants for the treatment of stress urinary incontinence

Objective

To compare the perioperative complications, failure rate, operating time, and length of hospital stay associated with 2 minimally invasive suburethral slings in the management of stress urinary incontinence in women.

Methods

Women diagnosed with stress urinary incontinence were treated with tension-free vaginal tape (TVT) or transobturator tape (TOT). The participants were followed for the next 2 years, with scheduled evaluations 6 weeks, then 3, 6, 12, and 24 months after surgery.

Results

Of the 104 participants, 55 were treated with TVT and 49 were treated with TOT. The condition was classified as “cured” in 81.8% of cases in the TVT group and 83.7% in the TOT group, and improvement occurred in 10.9% and 10.2% of cases, respectively. The mean operating time was shorter for patients treated with TOT than for those treated with TVT. There were no significant differences between the groups in terms of perioperative complications (abnormal voiding dysfunction, urinary infections, and de novo overactive bladder). The temporary and permanent urinary obstruction rates in the TVT group were approximately twice those in the TOT group.

Conclusion

Comparable complications and outcomes were observed with TVT and TOT. Tension-free vaginal implants are effective for the treatment of female stress urinary incontinence.