Modified in situ vaginal wall tape for treatment of stress urinary incontinence (Report of 10 cases)
-
摘要: 目的：探讨改良自体阴道前壁吊带治疗女性压力性尿失禁（SUI）的可行性及近期疗效。方法：参照TVT-O设计原理，采用自体原位阴道壁吊带治疗女性压力性尿失禁患者10例。取自体阴道壁吊带，将阴道壁吊带两端缝合于盆筋膜腱弓，无需特殊手术器械经闭孔穿刺。结果：10例患者都顺利完成手术，手术平均时间65 min，术中平均出血约35 ml。无一例出现假性囊肿、感染等并发症。住院时间4~7 d，平均5 d，术后10例患者尿失禁症状消失，无需配戴尿垫，患者主诉满意。随访9个月~2年，1例术后3个月时复发；1例术后出现排尿困难，给予导尿及药物治疗后症状改善。结论：自行设计改良的自体阴道壁吊带治疗女性压力性尿失禁安全可行，效果同TVT-O手术，但手术费用低。阴道壁吊带是自身组织，避免了TVT-O手术的尿道吊带侵蚀反应的发生。本组病例较少，长期疗效需进一步随诊观察。Abstract: Objective: To discuss the feasibility of modified in situ vaginal wall tape for treatment of stress urinary incontinence.Method: Ten patients who suffered with stress urinary incontinence were treated with modified in situ vaginal wall tape. The in situ vaginal wall tape replaced for the polypropylene tape being used in TVT-O operation and were sutured with the arcus tendineus of the endopelvic fascia, without the special surgical instruments for transobturator puncturing.Result: A total of 10 patients successfully underwent the anti-incontinence operation with the in situ vaginal wall tape. The mean operation time was 65 min and the mean blood loss was 35 ml. No severe complications were observed, such as bladder lesion, urethra injury, pseudocyst,infection, injury of obturator vessels and nerves. The mean hospital stay was 5 days (range 4-7 days). The syndrome of stress urinary incontinence disappeared after operation. The patients were followed up for 9-24 months. Of the 10 cases, 1 was recurrenced at the 3th month of postoperation and 1 had dysuria which was cured after urethral catheterization and drug treatment.Conclusion: Modified in situ vaginal wall tape treatment for female stress urinary incontinence was safe and feasible, the clinical efficacy being same as TVT-O. However, more economical, it greatly reduced the financial burden of patients and the urethral sling erosion reacations observed in TVT-O were avoided with the vaginal wall sling being its own organization. To assess the long term effects need further long term follow up study for fewer cases and lack of long-term follow-up study.
-
Key words:
- urinary incontinence, stress /
- female /
- modified /
- vaginal wall tape
-
-
[1] DeLancey J O. Structural support of the urethra as it relates to stress urinary incontinence:the hammock hypothesis[J]. Am J Obstet Gynecol, 1994, 170:1713-1720; discussion 1720-1723.
[2] Ulmsten U, Henriksson L, Johnson P, et al. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence[J]. Int Urogynecol J Pelvic Floor Dysfunct, 1996, 7:81-85; discussion 85-86.
[3] Delorme E. Transobturator urethral suspension:mini-invasive procedure in the treatment of stress urinary incontinence in women[J]. Prog Urol, 2001, 11:1306-1313.
[4] 李龙坤. 女性压力性尿失禁诊断治疗指南[M]. 见:那彦群, 叶章群, 孙颖浩, 等主编. 中国泌尿外科疾病诊断治疗指南. 北京:人民卫生出版社, 2009:19.
[5] Kenton K, Mueller E R. The global burden of female pelvic floor disorders[J]. BJU Int, 2006, 98 Suppl 1:1-5; discussion 6-7.
[6] Gunasekera P, Sazaki J, Walker G. Pelvic organ prolapse:don't forget developing countries[J]. Lancet, 2007, 369:1789-1790.
[7] Altman D, Väyrynen T, Engh M E, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse[J]. N Engl J Med, 2011, 364:1826-1836.
[8] Mustafa M, Wadie B S. In situ anterior vaginal wall sling for treatment of stress urinary incontinence:extended application and further experience[J]. Urol J, 2009, 6:35-39.
[9] Mustafa M. How to achieve long-term success in the treatment of female urinary stress incontinence? Novel modification on vaginal sling[J]. Korean J Urol, 2011, 52:184-188.
-
计量
- 文章访问数: 54
- PDF下载数: 172
- 施引文献: 0
下载: