Lovatsis Danny, Gupta Chander, Dean Erin, Lee Francis
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, St Boniface General Hospital, Winnipeg, Manitoba, Canada.
Am J Obstet Gynecol. 2003 Dec;189(6):1601-4; discussion 1604-5. doi: 10.1016/j.ajog.2003.09.041.
The purpose of this study was to evaluate the effect of obesity on the success of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. Specifically, do patients with a body mass index (BMI) of 35 kg/m(2) or greater have a lower cure rate of stress urinary incontinence?
This retrospective cohort study identified 35 patient pairs who had undergone TVT in Winnipeg, Manitoba, Canada, for stress urinary incontinence from November 1999 to July 2001. Obese patients (defined as BMI greater than or equal to 35 kg/m(2)) were paired with nonobese patients (defined as BMI less than or equal to 30 kg/m(2)). The subjects were matched for age (within 5 years) and prior continence surgeries. Patients with a maximum urethral closure pressure of less than or equal to 20 cm H(2)O were excluded. Follow-up was either by objective cough stress test or subjective cure assessed by telephone interview. Cure was defined as no postoperative stress incontinence. Statistical analysis was performed by conditional logistic regression for matched controls.
The follow-up range was 6 to 24 months. There were seven failures in all, four in obese and three in nonobese patients, giving cure rates of 88.6% and 91.4%, respectively. This difference was not statistically significant (P>.05). There were five bladder perforations (identified at the time of the procedure), all occurring in nonobese patients (P< .05).
These data do not demonstrate a difference in cure of TVT in obese versus nonobese patients. Given the finding of fewer complications, this procedure may be an ideal surgical treatment modality for stress urinary incontinence in obese women.
本研究旨在评估肥胖对无张力阴道吊带术（TVT）治疗压力性尿失禁成功率的影响。具体而言，体重指数（BMI）达到或超过35kg/m²的患者压力性尿失禁治愈率是否较低？
这项回顾性队列研究纳入了1999年11月至2001年7月在加拿大曼尼托巴省温尼伯市接受TVT治疗压力性尿失禁的35对患者。肥胖患者（定义为BMI大于或等于35kg/m²）与非肥胖患者（定义为BMI小于或等于30kg/m²）配对。受试者按年龄（相差5岁以内）和既往节制手术情况进行匹配。最大尿道闭合压小于或等于20cm H₂O的患者被排除。通过客观咳嗽压力试验或电话访谈进行主观治愈情况评估来进行随访。治愈定义为术后无压力性尿失禁。对匹配对照进行条件逻辑回归统计分析。
随访时间为6至24个月。总共出现7例治疗失败，肥胖患者4例，非肥胖患者3例，治愈率分别为88.6%和91.4%。这种差异无统计学意义（P>.05）。有5例膀胱穿孔（术中发现），均发生在非肥胖患者中（P<.05）。
这些数据未显示肥胖患者与非肥胖患者TVT治疗治愈率存在差异。鉴于并发症较少这一发现，该手术可能是肥胖女性压力性尿失禁理想的手术治疗方式。
