Doo Chin Kyung, Hong Bumsik, Chung Byung Joo, Kim Ji Yoon, Jung Hee Chang, Lee Kyu-Sung, Choo Myung-Soo
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eur Urol. 2006 Aug;50(2):333-8. doi: 10.1016/j.eururo.2006.04.007. Epub 2006 May 2.
We evaluated the long-term efficacy and safety of a tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence (SUI) in a Korean population.
We included 134 patients (mean age, 52.3+/-9.3 yr) who underwent the TVT procedure for SUI in three institutions and followed for 5 yr (mean, 67.0 mo; range, 60-76 mo) postoperatively. We analysed voiding diaries and complete multichannel urodynamic studies preoperatively as well as cough stress tests, uroflowmetry, and questionnaires postoperatively.
The overall 5-yr success rates (cure/improved) were 94.9% (76.9% and 18.0%, respectively), with an 86.6% patient satisfaction rate. Although the success rates between 1 and 5 yr were similar (97.7% vs. 94.9%), the cure rate decreased from 90.1% to 76.9% (p<0.001) at 5 yr. The 5-yr cure rate for mixed urinary incontinence (MUI) was 72.0%, which was not significantly different from pure SUI (78.0%, p>0.05). Maximal flow rate dropped from 25.9+/-10.3ml/s to 20.4+/-8.6ml/s at 1 mo postoperatively and recovered to 24.8+/-8.5ml/s at 5 yr. Complications included bladder perforation in 5 patients (3.7%), tape cutting or release in 11 (8.2%), and persistent suprapubic pain in 3 (2.2%). Urgency and urge incontinence improved in 46.7% and 48.0% of patients, respectively.
TVT was an effective and safe procedure for SUI and MUI with high success rates in the long-term follow-up. It also improved concomitant overactive bladder symptoms and initially reduced postoperative urine flow, which recovered over time.
我们评估了无张力阴道吊带术（TVT）治疗韩国女性压力性尿失禁（SUI）的长期疗效和安全性。
我们纳入了134例因SUI在三个机构接受TVT手术的患者（平均年龄52.3±9.3岁），术后随访5年（平均67.0个月；范围60 - 76个月）。我们分析了术前的排尿日记和完整的多通道尿动力学研究，以及术后的咳嗽压力试验、尿流率测定和问卷调查。
总体5年成功率（治愈/改善）为94.9%（分别为76.9%和18.0%），患者满意率为86.6%。虽然1年和5年的成功率相似（97.7%对94.9%），但5年时治愈率从90.1%降至76.9%（p<0.001）。混合性尿失禁（MUI）的5年治愈率为72.0%，与单纯SUI（78.0%，p>0.05）无显著差异。术后1个月最大尿流率从25.9±10.3ml/s降至20.4±8.6ml/s，5年时恢复至24.8±8.5ml/s。并发症包括5例膀胱穿孔（3.7%）、11例吊带切割或松解（8.2%）、3例耻骨上持续疼痛（2.2%）。尿急和急迫性尿失禁分别在46.7%和48.0%的患者中得到改善。
TVT是治疗SUI和MUI的有效且安全的手术，长期随访成功率高。它还改善了伴发的膀胱过度活动症症状，术后初期尿流减少，但随时间恢复。
