Ramon J, Mekras J, Webster G D
Division of Urology, Duke University Medical Center, Durham, North Carolina.
Urology. 1991 Dec;38(6):519-22. doi: 10.1016/0090-4295(91)80168-7.
The results of transvaginal needle suspension in 36 patients with stress urinary incontinence who failed previous operation were reviewed. Eighteen patients underwent a Stamey endoscopic needle suspension, and a Peyrera-Raz cystourethropexy was performed on the remainder. Recurrent stress incontinence was confirmed by history, physical examination, and urodynamic studies. Cure rates of 78 percent for the Stamey procedure and 83 percent for the Raz operation were achieved. Excluding patients with voiding dysfunction or urge incontinence postoperatively due to bladder instability, the failure rates were 6 percent and 11 percent, respectively. Analysis of the results according to the preoperative maximal urethral pressures demonstrated that low-pressure urethras if accompanied with urethrovesical hypermobility have no impact on the results if the anatomic abnormality was corrected adequately by the needle suspension. Thus, the transvaginal needle suspension was found to be highly effective in patients with low-pressure urethras, who failed previous operation, but had persistent bladder neck hypermobility, and suggests that this method of surgical repair should be the first choice in this selected group.
回顾性分析了36例既往手术失败的压力性尿失禁患者经阴道针悬吊术的结果。18例患者接受了斯塔梅内镜下针悬吊术，其余患者则进行了佩雷拉 - 拉兹膀胱尿道固定术。通过病史、体格检查和尿动力学研究确诊为复发性压力性尿失禁。斯塔梅手术的治愈率为78%，拉兹手术的治愈率为83%。排除术后因膀胱不稳定导致排尿功能障碍或急迫性尿失禁的患者，失败率分别为6%和11%。根据术前最大尿道压力对结果进行分析表明，如果针悬吊术能充分纠正解剖异常，伴有尿道膀胱活动过度的低压尿道对结果并无影响。因此，经阴道针悬吊术被发现对既往手术失败但仍存在持续性膀胱颈活动过度的低压尿道患者非常有效，这表明这种手术修复方法应成为该特定患者群体的首选。
