Lo Tsia-Shu, Chang Ting-Chang, Chao An-Shine, Chou Hung-Hsueh, Tseng Ling-Hong, Liang Ching-Chung
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, and Chang Gung University, College of Medicine, Tao-Ysuan Hsien, Taiwan.
Acta Obstet Gynecol Scand. 2003 Nov;82(11):1049-53. doi: 10.1034/j.1600-0412.2003.00316.x.
To study the efficacy of performing the tension-free vaginal tape (TVT) procedure concurrently with vaginal pelvic relaxation surgeries in the management of genuine stress incontinence with genital prolapse.
Fifty-eight women were surgically managed. Various vaginal pelvic reconstructive surgeries for prolapses were completed before the TVT procedure. Pre-operative and postoperative urodynamic studies, 1-h pad tests and symptom analysis were evaluated 1 year postoperatively. Surgical procedures and patient outcomes are discussed.
Objective data available for 55 patients. Fifty (91%) were dry 1 year postoperatively. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies and sacrospinous ligament fixations. No major surgical complications occurred. The average blood loss was 134 ml, the average operating time for the TVT procedure was 21 min, and the average postoperative hospital stay was 3.4 days. All patients voided spontaneously with adequate volumes of postvoid residual urine before being discharged. Two patients had a recurrent prolapse. Urodynamic parameters showed no significant differences before and after the surgery, except that the parameters related to voiding dysfunction were improved in the patients with severe cystocele. De nova detrusor instability was observed in one patient.
The tension-free vaginal tape procedure performed with concurrent vaginal pelvic relaxation surgery is safe and effective for genuine stress incontinence and pelvic prolapse. Concomitant procedures also appear to relieve bladder outlet obstructions caused by severe prolapse.
研究在治疗真性压力性尿失禁合并生殖器脱垂时，同时进行无张力阴道吊带（TVT）手术与阴道盆底松弛手术的疗效。
对58名女性进行手术治疗。在TVT手术前完成各种针对脱垂的阴道盆底重建手术。术后1年评估术前和术后的尿动力学研究、1小时护垫试验及症状分析。讨论手术步骤和患者预后。
55例患者有可用的客观数据。术后1年，50例（91%）患者无尿失禁。同期盆腔手术包括阴道全子宫切除术、前壁修补术、后壁修补术和骶棘韧带固定术。未发生重大手术并发症。平均失血量为134毫升，TVT手术平均操作时间为21分钟，术后平均住院时间为3.4天。所有患者在出院前均能自主排尿，残余尿量充足。2例患者出现复发脱垂。尿动力学参数在手术前后无显著差异，除了重度膀胱膨出患者中与排尿功能障碍相关的参数有所改善。1例患者出现新发逼尿肌不稳定。
同时进行阴道盆底松弛手术的无张力阴道吊带手术治疗真性压力性尿失禁和盆腔脱垂安全有效。同期手术似乎也能缓解严重脱垂引起的膀胱出口梗阻。
