Levin Ishai, Groutz Asnat, Gold Ronen, Pauzner David, Lessing Joseph B, Gordon David
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Neurourol Urodyn. 2004;23(1):7-9. doi: 10.1002/nau.10164.
A prospective study was undertaken to examine the incidence of surgical complications and medium-term outcomes of tension-free vaginal tape (TVT) surgery in a large, heterogeneous group of stress-incontinent women.
Surgery was tailored according to preoperative clinical and urodynamic findings: stress-incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post-operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post-operatively.
Three hundred and thirteen consecutive patients were prospectively studied. The mean follow-up period was 21.4 +/- 13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post-operatively. Eight (2.5%) patients had post-operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow-up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De-novo urge incontinence developed post-operatively in 20 (8.3%) patients.
The TVT procedure is associated with good medium-term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well-trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation.
开展一项前瞻性研究，以检查在一大组异质性压力性尿失禁女性中无张力阴道吊带术（TVT）的手术并发症发生率和中期结局。
根据术前临床和尿动力学检查结果进行手术：压力性尿失禁女性接受TVT手术，而伴有泌尿生殖系统脱垂的女性接受TVT联合脱垂修复术。术后患者计划在1、3、6和12个月进行评估，此后每年评估一次。所有患者在术后3个月进行尿动力学检查。
对313例连续患者进行了前瞻性研究。平均随访期为21.4±13.5个月。我们的系列中有16例（5.1%）发生了聚丙烯吊带膀胱内穿行，其中2例在术后3个月和15个月被诊断出。8例（2.5%）患者术后出现排尿困难，需要导尿超过7天。然而，仅1例需要经阴道切除吊带。4例（1.3%）患者被诊断为吊带阴道侵蚀，所有这些患者均通过局部切除侵蚀的吊带成功治疗。结局分析仅限于241例连续随访至少12个月的患者。主观上，16例（6.6%）患者仍有持续性轻度压力性尿失禁，尽管尿动力学检查显示另有17例（7%）患者有无症状括约肌失禁。20例（8.3%）患者术后新发急迫性尿失禁。
TVT手术中期治愈率良好，然而，它并非没有麻烦的并发症，应相应地告知患者。只有训练有素、熟悉盆腔解剖、手术替代方案和内镜技术的外科医生才能进行该手术。
