Efficacy and safety of transurethral erbium YAG laser in the treatment of postmenopausal female stress urinary incontinence
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摘要: 目的 回顾性分析经尿道Er：YAG铒激光治疗绝经后女性压力性尿失禁(stress urinary incontinence，SUI)的疗效和安全性。方法 收集2021年3月—2022年3月郑州大学附属郑州中心医院收治的绝经后女性SUI患者62例，年龄48~92岁，平均(64.36±10.52)岁。均给予经尿道Er：YAG铒激光治疗，比较治疗前和治疗后3、6个月的临床症状、国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-SF)评分、1 h尿垫试验漏尿量，尿动力学指标和并发症发生情况。结果 与治疗前比较，治疗后3个月55例有效，1 h尿垫试验漏尿量显著降低、腹压漏尿点压(abdominal leak point pressure，ALPP)和最大尿道闭合压(maximal urethral closure pressure，MUCP)显著增加，差异有统计学意义(P < 0.05)，但功能尿道长度差异无统计学意义；治疗后6个月与治疗前比较，随访到62例患者的1 h尿垫试验漏尿量显著减低，47例患者的ALPP、MUCP有明显改善；与治疗后3个月比较，治疗后6个月效果无明显下降，1 h尿垫试验漏尿量、ALPP、MUCP、功能尿道长度差异无统计学意义。与治疗前比较，治疗后3个月及6个月的最大尿流率和膀胱残余尿量无明显下降，差异无统计学意义。所有患者治疗过程中均无明显不良反应。结论 经尿道Er：YAG铒激光治疗是绝经后SUI患者安全有效的治疗方法之一。
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关键词:
- 经尿道Er：YAG铒激光 /
- 压力性尿失禁 /
- 绝经后
Abstract: Objective To retrospectively analyze the efficacy and safety of transurethral Er: YAG erbium laser in the treatment of postmenopausal women with stress urinary incontinence(SUI).Methods A total of 62 postmenopausal women(age 48-92 years, mean 64.36±10.52 years) with SUI received transurethral Er: YAG erbium laser treatment in our hospital during Mar. 2021 and Mar. 2022. The results of ICI-Q-SF, urine leakage volume of 1 h urine cushion test, urodynamic indicators and complication were recorded before treatment, 3 months after treatment, 6 months after treatment for comparative analysis.Results Compared with before treatment, 55 patients were effective, urine leakage volume of 1 h urine cushion test was significantly reduced, while ALPP and MUCP were significantly increased in 3 months after treatment. The difference was statistically significant. But there was no statistical difference in the length of functional urethra between before treatment and 3 months after treatment. Compared with before treatment, 62 patients' urine leakage volume of 1 h urine cushion test were significantly reduced, and 47 patients were followed up who ALPP and MUCP were significantly improved after 6 months of treatment. Compared with 3 months after treatment, there was no significant decrease in efficacy after 6 months of treatment, and there was no significant difference in urine leakage volume of 1 h urine cushion test, ALPP, MUCP, functional urethra length. There was no significant difference in maximum urine flow rate and bladder residual urine volume between before treatment and 3 months after treatment or 6 months of treatment. No adverse actions were observed during treatment.Conclusion Transurethral Er: YAG erbium laser therapy is one of the safe and effective treatment methods for postmenopausal patients with SUI. -
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表 2 治疗前、治疗后3个月、治疗后6个月观察指标比较
X±S 时间 ICI-Q-SF评分 1 h尿垫试验漏尿量/g ALPP/cmH2Oa) MUCP/cmH2O 功能尿道长度/cm 最大尿流率/(mL/s) 残余尿量/mL 治疗前 10.35±4.76 8.48±10.55 85.56±26.58 47.32±13.78 2.90±0.50 23.68±7.39 4.34±5.54 治疗后3个月 4.47±4.21 5.93±7.011) 103.26±27.551) 59.30±16.111) 2.94±0.53 23.63±7.25 5.40±5.83 治疗后6个月 4.84±4.15 5.88±7.161) 103.45±26.721) 59.72±15.981) 2.96±0.52 23.79±7.01 5.82±6.51 注：a)1 cmH2O=0.098 kPa; 与治疗前比较，1) P < 0.05。 
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[1] 黄健. 中国泌尿外科和男科疾病诊断治疗指南: 2019版[M]. 北京: 科学出版社, 2020.
[2] Nambiar AK, Arlandis S, Bø K, et al. European association of urology guidelines on the diagnosis and management of female non-neurogenic lower urinary tract symptoms. part 1: diagnostics, overactive bladder, stress urinary incontinence, and mixed urinary incontinence[J]. Eur Urol, 2022, 82(1): 49-59. doi: 10.1016/j.eururo.2022.01.045
[3] 吕坚伟, 吕婷婷, 司俊文, 等. 经尿道Er: YAG铒激光治疗女性轻中度压力性尿失禁的疗效分析[J]. 现代泌尿外科杂志, 2019, 24(4): 268-271. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK202111004.htm
[4] 许盛飞, 秦保龙, 杜广辉, 等. 经尿道联合经阴道Smooth模式铒激光照射治疗女性压力性尿失禁的疗效评价[J]. 临床泌尿外科杂志, 2021, 36(6): 481-484. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2021.06.012
[5] 张维宇, 胡浩, 王起, 等. 女性压力性尿失禁患者术前尿动力学检查的意义[J]. 北京大学学报(医学版), 2016, 48(4): 655-658. doi: 10.3969/j.issn.1671-167X.2016.04.017
[6] Yande SD, Joglekar OV, Joshi M. Role of urodynamics in stress urinary incontinence: a critical appraisal[J]. J Midlife Health, 2016, 7(3): 119-125.
[7] Okui N, Miyazaki H, Takahashi W, et al. Comparison of urethral sling surgery and non-ablative vaginal Erbium: YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis[J]. Lasers Med Sci, 2022, 37(1): 655-663. doi: 10.1007/s10103-021-03317-x
[8] Erel CT, Fernandez LDC, Inan D, et al. Er: YAG laser treatment of urinary incontinence after failed TOT/TVT procedures[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 252: 399-403. doi: 10.1016/j.ejogrb.2020.07.010
[9] Lin KL, Chou SH, Long CY. Effect of Er: YAG laser for women with stress urinary incontinence[J]. Biomed Res Int, 2019, 2019: 7915813.
[10] Kuszka A, Gamper M, Walser C, et al. Erbium: YAG laser treatment of female stress urinary incontinence: midterm data[J]. Int Urogynecol J, 2020, 31(9): 1859-1866. doi: 10.1007/s00192-019-04148-9
[11] Gaspar A, Brandi H. Non-ablative erbium YAG laser for the treatment of type Ⅲ stress urinary incontinence(intrinsic sphincter deficiency)[J]. Lasers Med Sci, 2017, 32(3): 685-691. doi: 10.1007/s10103-017-2170-5
[12] Fistonić I, Fistonić N. Baseline ICIQ-UI score, body mass index, age, average birth weight, and perineometry duration as promising predictors of the short-term efficacy of Er: YAG laser treatment in stress urinary incontinent women: a prospective cohort study[J]. Lasers Surg Med, 2018.
[13] Erel CT, Inan D, Mut A. Predictive factors for the efficacy of Er: YAG laser treatment of urinary incontinence[J]. Maturitas, 2020, 132: 1-6. doi: 10.1016/j.maturitas.2019.11.003
[14] 袁晓奕. 铒激光技术治疗压力性尿失禁[J]. 临床外科杂志, 2020, 28(2): 113-115. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK202002004.htm
[15] Conté C, Jauffret T, Vieillefosse S, et al. Laser procedure for female urinary stress incontinence: a review of the literature[J]. Prog Urol, 2017, 27(17): 1076-1083.
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