Wadie Bassem S, Edwan Ayman, Nabeeh Adel M
Urology and Nephrology Center, Mansoura, Egypt. Bassem
J Urol. 2005 Sep;174(3):990-3. doi: 10.1097/01.ju.0000169492.96167.fe.
The incidence of urinary incontinence in women of childbearing age is about 30%. Around half have stress incontinence. Many treatment modalities have been elucidated to treat stress incontinence, and among the most popular are rectus fascia sling and tension-free vaginal tape (TVT). The introduction of TVT to the urological armamentarium put a multiplicity of synthetic materials into use in the correction of stress urinary incontinence. A comparison of the impact of these 2 commonly used techniques is needed.
A total of 53 female patients older than 21 years (mean age 45.09) were randomized, using closed envelopes, to undergo TVT or rectus fascia sling. Randomization was performed after patients received spinal anesthesia. One surgeon performed the 2 types of treatment. Associated grade 2 cystocele was simultaneously corrected. Patients with bladder or urethral pathology, as well as those with cystocele greater than grade 2, were excluded from analysis.
All 53 patients completed 6 months of followup and all had stress urinary incontinence. There were 15 patients who underwent sling surgery and 17 who underwent TVT who had concomitant grade 1 or 2 cystocele. No statistically significant difference was found between the 2 groups at baseline. Cure was accomplished in 23 of 25 (92%) with sling and in 26 of 28 (92.9%) with TVT at first followup visit (1 week). There were 7 patients who needed at least 1 extra week of catheterization in the sling group and 3 in the TVT group. No significant difference was detected in terms of post-void residual urine, symptom score, and filling and voiding parameters. At 6 months 1 patient had de novo detrusor overactivity and 7 had wound pain. Compared to those with TVT, 2 cases of sling were considered treatment failures, none had de novo overactivity and 2 had wound pain. None of the patients had symptoms suggestive of urethral erosion.
Rectus fascia sling and TVT seem to be equally effective regarding primary outcome measure (ie cure of stress incontinence). Symptom score related to incontinence surgery as well as simultaneous correction of cystocele are comparable in the 2 groups. Fascial sling is a longer treatment process yet it is more economical. Longer followup is vital before rigorous conclusions can be drawn.
育龄女性尿失禁的发生率约为30%。其中约一半为压力性尿失禁。目前已经阐明了多种治疗压力性尿失禁的方法，最常用的是腹直肌筋膜吊带术和无张力阴道吊带术（TVT）。TVT引入泌尿外科治疗手段后，多种合成材料被用于治疗压力性尿失禁。需要比较这两种常用技术的效果。
共53例年龄大于21岁（平均年龄45.09岁）的女性患者，采用密封信封随机分组，分别接受TVT或腹直肌筋膜吊带术治疗。患者在接受脊髓麻醉后进行随机分组。由同一位外科医生实施这两种治疗。同时对合并的2级膀胱膨出进行矫正。排除膀胱或尿道病变患者以及膀胱膨出大于2级的患者进行分析。
所有53例患者均完成了6个月的随访，均患有压力性尿失禁。15例行吊带手术，17例行TVT手术的患者合并1级或2级膀胱膨出。两组在基线时未发现统计学显著差异。首次随访（1周）时，吊带组25例中有23例（92%）治愈，TVT组28例中有26例（92.9%）治愈。吊带组有7例患者需要至少额外1周的导尿，TVT组有3例。在残余尿量、症状评分以及充盈和排尿参数方面未检测到显著差异。6个月时，1例患者出现新发逼尿肌过度活动，7例患者有伤口疼痛。与TVT组相比，吊带组有2例被视为治疗失败，无新发逼尿肌过度活动，2例有伤口疼痛。所有患者均无提示尿道侵蚀的症状。
腹直肌筋膜吊带术和TVT在主要结局指标（即压力性尿失禁的治愈）方面似乎同样有效。两组在与尿失禁手术相关的症状评分以及膀胱膨出的同期矫正方面相当。筋膜吊带术治疗过程较长，但更经济。在得出严格结论之前，更长时间的随访至关重要。
