Fulmer Brant R, Sakamoto Kyoko, Turk Thomas M T, Galen Donald, Presthus James B, Abbott Karen, Ross Jim, Ou Chau-Su, Albala David M
Geisinger Medical Center, Danville, Pennsylvania, USA.
J Urol. 2002 Jan;167(1):141-5.
A new treatment modality for women with stress urinary incontinence secondary to urethral hypermobility is radio frequency bladder neck suspension. Radio frequency energy is a form of electromagnetic energy that is reliable and highly controllable. This thermal therapy can produce well-defined areas of tissue heating. The technology has been used extensively in dermatological and orthopedic surgery for tissue shrinkage and ablation. Radio frequency thermal therapy is now being applied to the endopelvic fascia at the bladder neck and urethra for treating hypermobility in patients with stress urinary incontinence. The purported mechanism is shrinkage of the collagenated tissue that supports the bladder neck and proximal urethra. We report our acute and long-term experience with laparoscopic radio frequency bladder neck suspension for stress urinary incontinence.
Enrolled in this prospective multicenter trial were 94 women with a mean age of 48.4 +/- 7.6 years who had urethral hypermobility with an average cotton swab angle change of 41 degrees and Valsalva leak point pressures greater than 90 cm. water at 250 ml. bladder capacity. Detrusor instability was excluded by cystometry. In all cases precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The primary end points were physician assessment of continence, patient reported pad use and the number of patient reported episodes of urinary incontinence daily 1, 3, 6 and 12 months after surgery.
Average operative time was less than 60 minutes and 98% of the patients were discharged home from the recovery room. Treatment surface area decreased an average of 17% in length and 21% in width. Preoperatively 78% of patients had an average of 1 or more episodes of urinary incontinence daily. At 1, 3, 6 and 12 months there was an average of 1 or fewer episodes of urinary incontinence daily in 84.7%, 85.6%, 85.9% and 77.4% of patients, respectively, and at 12 months 83.5% reported being continent or improved. Preoperatively 41.2% of patients reported using 1 pad or less daily, while at 1, 3, 6 and 12 months 85.6%, 90.4%, 87.2% and 86.9%, respectively, required 1 pad or less daily. Urodynamic evaluation at 12 months showed no leakage during the Valsalva maneuver in 78% of cases. There were no major postoperative complications and the minor complication rate was 5.3%.
Early results of thermal treatment of the endopelvic fascia indicate that radio frequency bladder neck suspension is safe and effective for improving stress urinary incontinence in women. The improvement in symptomatology appears to be durable in most patients at the 1-year followup. Longer followup is needed to assess the durability of results and it is currently in progress.
对于因尿道活动过度导致压力性尿失禁的女性，一种新的治疗方式是射频膀胱颈悬吊术。射频能量是一种可靠且高度可控的电磁能形式。这种热疗法能产生界限清晰的组织加热区域。该技术已在皮肤科和矫形外科广泛用于组织收缩和消融。现在射频热疗法正应用于膀胱颈和尿道处的盆腔内筋膜，以治疗压力性尿失禁患者的尿道活动过度。其据称的机制是支撑膀胱颈和近端尿道的胶原组织收缩。我们报告我们在腹腔镜射频膀胱颈悬吊术治疗压力性尿失禁方面的急性和长期经验。
94名平均年龄为48.4±7.6岁的女性纳入了这项前瞻性多中心试验，她们存在尿道活动过度，棉拭子平均角度变化为41度，膀胱容量为250ml时腹压漏尿点压力大于90cm水柱。通过膀胱测压排除逼尿肌不稳定。在所有病例中，精确控制的射频能量应用于盆腔内筋膜以加热和收缩组织。主要终点是术后1、3、6和12个月医生对尿失禁的评估、患者报告的护垫使用情况以及患者报告的每日尿失禁发作次数。
平均手术时间少于60分钟，98% 的患者从恢复室出院回家。治疗表面积长度平均减少17%，宽度平均减少
