Gutiérrez Baños Jose Luis, Martín García Bernardo, Portillo Martín Jose Antonio, del Valle Schaan Jose Ignacio, Hernández Rodríguez Rafael, Correas Gómez Miguel Angel, Roca Edreira Antonio, Hernández Castillo Alberto, Ruiz Izquierdo Francisco, Aguilera Tubet Carmen
Servicio de Urología, Hospital Universitario Valdecilla, Santander, Cantabria, España.
Arch Esp Urol. 2003 Oct;56(8):885-92.
To analyze our results in terms of continence and complications of treatment of urinary incontinence with TVT during the 4 first years.
72 patients underwent surgery for urinary incontinence between 1999 and 2002. Chart review was performed for medical history, physical examination, urodynamic tests, surgical procedure, intraoperative and postoperative complications, objective and subjective results.
62 patients were diagnosed of genuine stress urinary incontinence and 10 patients of mixed urinary incontinence. 14 patients had grade 3 cystocele, 12 of them underwent associated colporrhaphy. Operations were performed under local anaesthesia in 1 patient, spinal anaesthesia in 41 and general anaesthesia in 30. Mean operation time was 32 minutes, 66 minutes when colporrhaphy was associated, and previous surgery did not increase the surgical difficulty. 6 patients (8.3%) suffered bladder perforation which was identified during cystoscopy, but only required reposition of the tape without affecting patients' outcomes; 1 patient had a pelvic hematoma that evolved without sequel; 16 patients (22.22%) had urinary retention which spontaneously resolved between 2 and 60 days, except one case that required section of the mesh. 8 patients (11.11%) developed de novo bladder instability; there were 2 cases of late mesh perforation into urethra or bladder, which were solved by endoscopic mesh section; 3 patients had voiding discomfort and 1 chronic perineum pain. 70 patients (97.3%) achieved continence under stress; nevertheless only 57 patients (79.17%) were satisfied with their outcomes. Main causes for dissatisfaction were failure, de novo instability, persistence of urgency in cases of mixed incontinence, and voiding discomfort. Previous surgery and performance of associated procedures did not influence outcomes, although they were associated with longer operation times and higher incidence of urinary retention. Patients with Valsalva's leak point pressure < 60 H2O cm had slightly worse outcomes (63.5% satisfaction).
TVT is an easy to learn and easy to perform technique, with few complications and good results.
分析头4年期间采用经阴道无张力尿道中段悬吊带术（TVT）治疗尿失禁的控尿情况及并发症的结果。
1999年至2002年间，72例患者接受了尿失禁手术。对病史、体格检查、尿动力学检查、手术过程、术中及术后并发症、客观和主观结果进行病历回顾。
62例患者被诊断为真性压力性尿失禁，10例为混合性尿失禁。14例患者有3级膀胱膨出，其中12例同时接受了阴道前壁修补术。1例患者在局部麻醉下手术，41例在脊髓麻醉下手术，30例在全身麻醉下手术。平均手术时间为32分钟，若同时行阴道前壁修补术则为66分钟，既往手术未增加手术难度。6例患者（8.3%）发生膀胱穿孔，在膀胱镜检查时发现，但仅需重新放置吊带，未影响患者结局；1例患者发生盆腔血肿，未遗留后遗症；16例患者（22.22%）出现尿潴留，在2至60天内自行缓解，除1例需要切断网片。8例患者（11.11%）出现新发膀胱不稳定；有2例晚期网片穿入尿道或膀胱，通过内镜下切断网片解决；3例患者有排尿不适，1例有慢性会阴部疼痛。70例患者（97.3%）在压力状态下实现控尿；然而，只有57例患者（79.17%）对其结局满意。不满意的主要原因是手术失败、新发不稳定、混合性尿失禁患者持续存在尿急以及排尿不适。既往手术和同时进行相关手术不影响结局，尽管它们与手术时间延长和尿潴留发生率较高有关。Valsalva漏点压力<60 cmH₂O的患者结局稍差（满意度为63.5%）。
TVT是一种易于学习和操作的技术，并发症少，效果良好。
