Wang K H, Wang K H, Neimark M, Davila G W
Armed Forces Taichung General Hospital, Taichung, Taiwan, ROC.
Int Urogynecol J Pelvic Floor Dysfunct. 2002 Nov;13(6):353-7; discussion 358. doi: 10.1007/s001920200079.
The aim of the study was to assess the incidence of abnormal voiding in patients who had undergone tension-free vaginal tape (TVT) placement. Women who had undergone a TVT sling procedure for stress or mixed incontinence more than 3 months previously reported their voiding habits (frequency, urgency, nocturia, urinary stream quality and incontinence) over the previous 3 days. A pelvic examination and ultrasound postvoid residual (PVR) were performed. Normal voiding was classified as a PVR <100 ml, frequency of six or fewer voids per day and two or fewer per night, and a urinary stream considered normal by the patient. Subjects were classified as either 'normal' (group 1) or 'abnormal' (group 2) voiders. Demographic factors, pre-operative urodynamic testing and concomitant surgical procedures were compared between groups. From September 1999 to November 2000, 59 women underwent a TVT procedure. Two were excluded from analysis [cervical malignancy (1), interstitial cystitis (1)]. There were no healing abnormalities and no patients displayed a positive empty bladder stress test. Forty-two (74%) women were included in group 1 and 15 (26%) in group 2. Urinary continence was reported by 49 (86%): 93% in group 1 and 67% in group 2. Factors highly correlated with postoperative voiding dysfunction included abnormal preoperative uroflow pattern and configuration (P = 0.007), preoperative low peak flow rate <15 ml/s (P = 0.049), preoperative vault prolapse or enterocele (P = 0.001), concurrent vault suspension surgery (P = 0.03) and postoperative urinary tract infection (UTI) (P = 0.0006). Preoperative urinary retention (postvoid residual >100 ml) or detrusor instability, age and body mass index differences were not statistically significant. Multivariate analysis revealed that preoperative abnormal uroflow and postoperative UTI were related to group 2 (P = 0.02). Our conclusions were that the TVT sling procedure has success and voiding dysfunction rates similar to those of other proven anti-incontinence procedures. Various factors were shown to be associated with postoperative voiding difficulties. Tension-free placement of the tape may not prevent the development of post-operative voiding dysfunction.
本研究的目的是评估接受无张力阴道吊带术（TVT）的患者中排尿异常的发生率。在3个多月前因压力性或混合性尿失禁接受TVT吊带手术的女性，报告了她们在过去3天的排尿习惯（频率、尿急、夜尿、尿流质量和尿失禁情况）。进行了盆腔检查和排尿后残余尿量超声检查（PVR）。正常排尿被定义为PVR＜100ml、每天排尿6次或更少且每晚排尿2次或更少，以及患者认为尿流正常。受试者被分为“正常”排尿者（第1组）或“异常”排尿者（第2组）。比较了两组之间的人口统计学因素、术前尿动力学检测结果和同期手术情况。1999年9月至2000年11月，59名女性接受了TVT手术。2例被排除在分析之外[宫颈癌（1例）、间质性膀胱炎（1例）]。未出现愈合异常情况，且没有患者的膀胱排空压力试验呈阳性。第1组纳入42名（74%）女性，第2组纳入15名（26%）女性。49名（86%）患者报告尿失禁得到改善：第1组为93%，第2组为67%。与术后排尿功能障碍高度相关的因素包括术前尿流模式和形态异常（P = 0.007）、术前最大尿流率＜15ml/s（P = 0.049）、术前穹窿脱垂或肠疝（P = 0.001）、同期穹窿悬吊手术（P = 0.03）以及术后尿路感染（UTI）（P = 0.0006）。术前尿潴留（排尿后残余尿量＞100ml）或逼尿肌不稳定、年龄和体重指数差异无统计学意义。多因素分析显示，术前异常尿流和术后UTI与第2组相关（P = 0.02）。我们的结论是，TVT吊带手术的成功率和排尿功能障碍发生率与其他已证实的抗尿失禁手术相似。多种因素被证明与术后排尿困难有关。吊带的无张力放置可能无法预防术后排尿功能障碍的发生。
