Giberti C, Rovida S
Division of Urology, San Paolo Hospital, Savona, Italy.
Urology. 2000 Dec 20;56(6):956-61. doi: 10.1016/s0090-4295(00)00847-5.
To evaluate the results and complications of a new transvaginal minimally invasive procedure for the treatment of stress urinary incontinence.
Sixty-seven women aged 37 to 77 years underwent a pervaginal bone-anchoring synthetic sling procedure between April 1997 and February 1999. Sixty-three patients had a defect of the anatomic support, and 4 had iatrogenic intrinsic sphincteric deficiency (ISD). Patients were assessed at least 1 year postoperatively, underwent physical examination, and filled in the self-assessment questionnaire with the help of a nonpartisan health care provider. The questionnaire inquired about urine leakage, obstructive and irritative symptoms, quality of life, and satisfaction with the treatment received. The physician and questioner had no knowledge of each other.
Mean follow-up was 17 months. Perfect dryness was seen in 82% of patients with improvement in 9% and failure in 9%. Patients reporting a failed outcome were significantly older than those reporting improvement or cure (P = 0.01). All patients with ISD failed. Moderate obstructive symptom scores have been noticed in 31% of patients. Irritative voiding symptoms have been recorded in 22% of cured patients and 83% and 80% of improved and failed patients, respectively (P <0.001). Three percent of patients experienced pain during intercourse. Mild pelvic pain was found in 8% of patients. The only main complication of the operation was the vaginal erosion and sling removal in 16% of patients. Seventy-two percent of patients were completely satisfied with the treatment received.
This procedure allows a high cure rate in patients with urinary incontinence due to a defect of anatomic support, and it is unsuitable when incontinence is due to ISD. The only main complication came from the use of the gelatin-coated Dacron sling that resulted in vaginal erosion, often necessitating the sling removal. The use of different synthetic or nonsynthetic materials may be advisable.
评估一种用于治疗压力性尿失禁的新型经阴道微创手术的效果及并发症。
1997年4月至1999年2月期间，67名年龄在37至77岁之间的女性接受了经阴道骨锚定合成吊带手术。63例患者存在解剖学支持缺陷，4例存在医源性内在括约肌缺陷（ISD）。术后至少对患者进行1年的评估，进行体格检查，并在无党派医疗保健人员的帮助下填写自我评估问卷。问卷询问了尿液渗漏、梗阻性和刺激性症状、生活质量以及对所接受治疗的满意度。医生和提问者相互不知情。
平均随访17个月。82%的患者实现了完全干爽，9%的患者有所改善，9%的患者治疗失败。报告治疗失败的患者明显比报告改善或治愈的患者年龄大（P = 0.01）。所有ISD患者均治疗失败。31%的患者出现中度梗阻症状评分。22%的治愈患者出现刺激性排尿症状，改善和失败患者中分别有83%和80%出现此类症状（P <0.001）。3%的患者在性交时感到疼痛。8%的患者出现轻度盆腔疼痛。手术的唯一主要并发症是16%的患者出现阴道侵蚀并取出吊带。72%的患者对所接受的治疗完全满意。
该手术对因解剖学支持缺陷导致尿失禁的患者治愈率较高，而对因ISD导致的尿失禁则不适用。唯一的主要并发症来自使用明胶涂层涤纶吊带导致的阴道侵蚀，这通常需要取出吊带。使用不同的合成或非合成材料可能是可取的。
