Delorme Emmanuel, Droupy Stéphane, de Tayrac Renaud, Delmas Vincent
Urology, 24 avenue Jean-Jaurès, 71100 Châlon sur Saône, France.
Eur Urol. 2004 Feb;45(2):203-7. doi: 10.1016/j.eururo.2003.12.001.
Assessment of one-year results of a new technique of transobturator suburethral tape in the treatment of female stress urinary incontinence.
UraTape, a non-woven, non-elastic polypropylene tape with a 15 mm long central (suburethral) silicone-coated section was inserted via the transobturator route. The tape is inserted tension-free in a horizontal plane underneath the middle of the urethra between the two obturator foramens. The ends of the tape are tunnelled percutaneously with a tunneller. As the retropubic space is preserved intact, cystoscopy is not required. From May 2000 to February 2002, 150 patients with stress urinary incontinence without associated prolapse were operated and a minimum of 1 year follow-up was available for 32 patients (mean follow-up 17 months; range 13-29). The mean age was 64 years (range 50-81). All patients were assessed before surgery by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closure pressure <20 cm H(2)O); 5 patients presented with recurrent urinary incontinence after Burch procedure or TVT; 18 patients presented with mixed incontinence, six of them with detrusor instability confirmed by cystometry. The results were evaluated by two independent investigators (clinical examination, uroflowmetry, cough test). Voiding disorders suggesting bladder outflow obstruction were defined as the presence of the following two criteria: Q(max)<15 ml/s, residual urine volume >20%.
29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. Mean operating time was 15minutes. No intra-operative complications were recorded. One patient had complete postoperative bladder retention which resolved after 4 weeks of self-catheterization. There were no problems with urethral erosion, residual pain or functional impairment related to the tape. 5/32 patients had voiding disorders suggesting bladder outflow obstruction. Two patients developed de novo urge incontinence.
Uratape transobturator tape is a simple and effective procedure with follow-up of one year for the treatment of female stress urinary incontinence confirmed after 1 year of follow-up. The transobturator approach avoids the risk of bladder, bowel or vascular injuries. Evaluation of the results after a longer follow-up period is needed to validate this technique.
评估经闭孔尿道下吊带新技术治疗女性压力性尿失禁的一年疗效。
UraTape是一种非编织、无弹性的聚丙烯吊带，中央（尿道下）有一段15毫米长的硅胶涂层部分，经闭孔途径插入。吊带在尿道中部下方的水平平面无张力插入，位于两个闭孔之间。吊带两端用隧道器经皮穿出。由于耻骨后间隙保持完整，无需进行膀胱镜检查。2000年5月至2002年2月，对150例无相关脱垂的压力性尿失禁患者进行了手术，32例患者获得了至少1年的随访（平均随访17个月；范围13 - 29个月）。平均年龄为64岁（范围50 - 81岁）。所有患者在手术前均通过临床和尿动力学检查进行评估：5例患者存在括约肌功能不全（最大闭合压<20 cm H₂O）；5例患者在Burch手术或经阴道无张力尿道中段吊带术（TVT）后出现复发性尿失禁；18例患者为混合性尿失禁，其中6例经膀胱测压证实存在逼尿肌不稳定。结果由两名独立研究者进行评估（临床检查、尿流率测定、咳嗽试验）。提示膀胱出口梗阻的排尿障碍定义为存在以下两个标准：最大尿流率（Qmax）<15 ml/s，残余尿量>20%。
29/32例患者（90.6%）治愈，3/32例（9.4%）改善。平均手术时间为15分钟。未记录术中并发症。1例患者术后出现完全性膀胱潴留，经4周自我导尿后缓解。未出现与吊带相关的尿道侵蚀、残留疼痛或功能障碍问题。5/32例患者存在提示膀胱出口梗阻的排尿障碍。2例患者出现新发急迫性尿失禁。
UraTape经闭孔吊带术是一种简单有效的手术方法，随访一年证实对女性压力性尿失禁治疗有效。经闭孔途径避免了膀胱、肠道或血管损伤的风险。需要更长随访期的结果评估来验证该技术。
