Giri Subhasis K, Drumm John, Saunders Jean A, McDonald Jane, Flood Hugh D
Department of Urology, Mid-Western Regional Hospital and National Institute of Health Sciences, University of Limerick, Ireland.
BJU Int. 2005 Apr;95(6):827-32. doi: 10.1111/j.1464-410X.2005.05410.x.
To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short-term cure rate for stress urinary incontinence (SUI).
Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of > or = 75%, a visual analogue scale pain score, perioperative complications, and short-term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was > or = 75% or when they were self-catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months.
The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6-month follow-up.
In the present study only 40% of patients were suitable for day-case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short-term results of this PVS are similar to those obtained with the autologous fascial sling.
前瞻性评估猪真皮耻骨阴道吊带术（PVS）后10小时出院的可行性，研究影响出院的手术因素（术后并发症），并测定压力性尿失禁（SUI）的短期治愈率。
2003年6月至2003年12月，40例连续的SUI患者计划采用猪真皮吊带进行治疗，纳入本前瞻性研究。患者入院时计划过夜留观，术后不带尿管返回病房。观察指标包括术后10小时膀胱排空效率（EE）、首次三次自主排尿的时间间隔、首次三次排尿的EE、达到EE≥75%所需时间、视觉模拟评分法疼痛评分、围手术期并发症以及SUI的短期治愈率。当EE≥75%或患者能自信地自行导尿且疼痛得到充分控制且无明显并发症时，认为患者适合出院。所有患者随访6个月。
术后10小时EE的中位数为61%；16例患者（40%）实现了有效排空，适合术后10小时出院。首次三次自主排尿的时间间隔中位数分别为7、10和17小时，首次三次排尿的EE中位数分别为46%、61%和75%。视觉模拟评分法疼痛评分中位数为3.5。内在括约肌缺陷（ISD）患者在术后10小时实现有效排空的可能性显著较低（39%对70%）。6个月随访时，90%的患者SUI得到治愈或改善。
在本研究中，仅40%的患者适合日间吊带手术。早期膀胱排空效率低下是主要限制因素。排除ISD患者并可能将EE阈值降至50%将提高出院率。该PVS的短期结果与自体筋膜吊带相似。
