Jomaa M
Department of Obstetrics and Gynaecology, Växjö Central Hospital, S-351 85 Växjö, Sweden.
Gynecol Obstet Invest. 2001;51(3):184-6. doi: 10.1159/000052921.
To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse.
The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary.
In total 32 patients participated. All suffered from urinary stress incontinence (grade 1-3) and prolapse (grade 1-3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31-74) years, mean parity 2 (range 0-5), and mean duration of incontinence 13 (range 2-29) years.
TVT was carried out according to the standardized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia.
30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12-355) g preoperatively, and postoperatively 2.7 (range 0-28) g. Mean intraoperative bleeding was 75 (range 25-300) ml. Mean residual urine preoperatively was 15 (range 0-85) ml, and postoperatively 7 (range 0-40) ml. The mean stay in hospital after surgery was 2 (range 1-5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization.
The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.
研究在局部麻醉下，将无张力阴道吊带术（TVT）与盆底脱垂修复术联合应用于压力性尿失禁和盆底脱垂患者的情况。
本研究设计为一项前瞻性、开放性、非随机研究。采用标准化方案进行术前和术后评估。在术后2、6、12和24个月进行检查。该方案包括病史、压力测试（膀胱适度充盈时的仰卧位和站立位）、生活质量评估（包括视觉模拟评分）、24至48小时的护垫试验以及48小时的排尿日记。
共有32例患者参与。所有患者均患有压力性尿失禁（1 - 3级）和盆底脱垂（1 - 3级）。2例患者此前分别接受过2次和3次非TVT方法（传统抗尿失禁手术）治疗尿失禁。3例患者有全子宫切除术史。1例患者有巨大直肠膨出并伴有尿失禁和大便失禁。平均年龄为54岁（范围31 - 74岁），平均产次为2次（范围0 - 5次），平均尿失禁持续时间为13年（范围2 - 29年）。
TVT按照最初描述的标准化技术进行。盆底脱垂修复术包括前壁和/或后壁阴道修补术。所有手术均可在局部麻醉下进行。
32例患者中有30例（93%）治愈。1例患者（3%）有显著改善，1例患者（3%）被认为手术失败。术前24小时平均尿漏量为96克（范围12 - 355克），术后为2.7克（范围0 - 28克）。术中平均出血量为75毫升（范围25 - 300毫升）。术前平均残余尿量为15毫升（范围0 - 85毫升），术后为7毫升（范围0 - 40毫升）。术后平均住院时间为2天（范围1 - 5天）。未发生术后尿潴留、愈合不良或吊带排斥反应。1例曾接受传统尿失禁手术的患者发生了1次无不良后果的膀胱穿孔。该患者术后未留置导尿管，术后第一天出院。
该研究清楚地表明，TVT可与盆底脱垂手术联合应用，有效治疗盆底脱垂和压力性尿失禁症状。
