Cholhan Hilary J, Lotze Peter M
Department of OB/Gyn, University of Rochester, Women's Continence Center of Greater Rochester, 500 Helendale, Suite #265, Rochester, NY 14609, USA.
Int Urogynecol J Pelvic Floor Dysfunct. 2004 Jul-Aug;15(4):249-56. doi: 10.1007/s00192-004-1168-2.
Voiding dysfunction following sling procedures for correction of genuine stress urinary incontinence (GSI) is a frequently reported complication. This study sought to determine if voiding dysfunction could be reduced by eliminating sling tension against the urethra. Participants were diagnosed with GSI and randomized to one of two surgical groups. One received a conventional suburethral sling and the other received a modified sling placed at the mid-urethra without tension. Voiding trials after surgery monitored for voiding dysfunction. Multichannel urodynamic studies were performed pre- and post-operatively. Cure rates for GSI were similar for the two groups (91.7 vs. 88.5%). The 27 patients in the modified group voided an average of 5 days earlier than the 21 patients in the conventional group. Conventional group patients were more likely to have urinary retention (125 vs. 49 cc, p=0.03). The modified group had a lesser change in average closure pressure following surgery. Results suggested a higher increase in urethral resistance in the conventional group (0.72 vs. 1.88 cm H2O ml(-2) sec2). No differences were seen in symptomatic urinary urgency or urge incontinence following surgery. This study demonstrated a no-tension sling at the mid-urethra to afford equivalent cure of GSI with significant reduction of voiding dysfunction.
用于纠正真性压力性尿失禁（GSI）的吊带手术后出现排尿功能障碍是一种经常报道的并发症。本研究旨在确定消除吊带对尿道的张力是否可以减少排尿功能障碍。参与者被诊断为GSI，并随机分为两个手术组之一。一组接受传统的尿道下吊带，另一组接受置于尿道中段且无张力的改良吊带。术后进行排尿试验以监测排尿功能障碍。术前和术后均进行多通道尿动力学研究。两组GSI的治愈率相似（91.7%对88.5%）。改良组的27名患者比传统组的21名患者平均提前5天排尿。传统组患者更易出现尿潴留（125对49毫升，p = 0.03）。改良组术后平均闭合压变化较小。结果表明，传统组尿道阻力增加幅度更大（0.72对1.88厘米水柱·毫升⁻²·秒²）。术后有症状的尿急或急迫性尿失禁未见差异。本研究表明，尿道中段无张力吊带在有效治愈GSI的同时可显著减少排尿功能障碍。
