Muller M, Koebele A, Deval B
Département de Chirurgie Gynécologique, Maternité Universitaire de Nancy, France.
J Gynecol Obstet Biol Reprod (Paris). 2007 Feb;36(1):19-29. doi: 10.1016/j.jgyn.2006.11.004. Epub 2007 Jan 17.
To provide a critical assessment on the tension free vaginal tape procedure used to support the urethra in female urinary incontinence.
We identified articles related to Tension free vaginal tape through a MEDLINE search of English published literature from May 1998 to May 2006. Randomised control trial (RCTs) and retrospective clinical trials were selected including 478 publications on TVT (Tension-free Vaginal Tape), 55 on TOT) (Transobturator Tape), 17 on SPARC (Supra Pubic Arc), 2 on TPP) (Pre Pubic TVT). For the analysis of the functional results of the tape were not available: papers with a mean follow-up under 6 months, the invitation papers or non reviewed manuscript, the redundant papers in the same department, specific case control study.
RESULTS/DISCUSSION: Preoperative age over 70years old and morbid obesity do not seem to be a risk factor for failure of the TVT procedure; however, there is an increase of de novo urgency for age over 70 years old and BMI over 35. Suburetral tape procedure is highly effective in women with intrinsic sphincter deficiency. The urethral hypermobility increases the efficacy of the procedure, however women with fixed urethra, are at significantly increased risks for failure of the procedure. In the same way, preoperative mixed urinary incontinence and voiding difficulties alter the success rate of the procedure. The mode of anaesthesia and the topography of the tape (retropubic or transobturator) have no incidence on the results. There is a definite learning curve (n=20) for the efficiency and the morbidity of the procedure. Cranial topography of the tape and associated procedures are associated with urgency and voiding difficulties.
The prognosis factors having an effect on the success of the procedure are the urethral mobility, the mixed urinary incontinence, the learning curve, and the type of protheses.
对用于支持女性尿失禁患者尿道的无张力阴道吊带手术进行批判性评估。
通过检索1998年5月至2006年5月发表的英文医学文献，我们确定了与无张力阴道吊带相关的文章。选择了随机对照试验（RCT）和回顾性临床试验，包括478篇关于无张力阴道吊带术（TVT）的出版物、55篇关于经闭孔吊带术（TOT）的、17篇关于耻骨上弧形吊带术（SPARC）的、2篇关于耻骨前无张力阴道吊带术（TPP）的。对于吊带功能结果的分析不可用的情况包括：平均随访时间不足6个月的论文、邀请论文或未经评审的手稿、同一科室的冗余论文、特定病例对照研究。
结果/讨论：术前年龄超过70岁和病态肥胖似乎不是TVT手术失败 的危险因素；然而，70岁以上且体重指数超过35的患者新发尿急情况有所增加。尿道下吊带手术对内在括约肌缺陷的女性非常有效。尿道活动度过高会提高手术疗效，然而尿道固定的女性手术失败风险显著增加。同样，术前混合性尿失禁和排尿困难会改变手术成功率。麻醉方式和吊带位置（耻骨后或经闭孔）对结果没有影响。该手术的效率和发病率存在明确的学习曲线（n = 20）。吊带的头侧位置及相关手术与尿急和排尿困难有关。
影响手术成功的预后因素包括尿道活动度、混合性尿失禁、学习曲线和假体类型。
