Paick Jae-Seung, Cho Min Chul, Oh Seung-June, Kim Soo Woong, Ku Ja Hyeon
Department of Urology, Seoul National University Hospital, Seoul, Korea.
J Urol. 2007 Sep;178(3 Pt 1):985-9; discussion 989. doi: 10.1016/j.juro.2007.05.026. Epub 2007 Jul 16.
We evaluated the outcome at least 6 months after the tension-free vaginal tape or transobturator tape procedure in women with urinary incontinence, and identified factors predicting persistent stress urinary incontinence.
A total of 464 women 28 to 80 years old (mean age 56) were included in the study. Tension-free vaginal tape (252) and transobturator tape (212) procedures were performed by the same surgeon. Mean followup was 10.8 months (range 6 to 52).
Bladder perforations were noted in 12 patients (4.8%) in the tension-free vaginal tape group but there was no bladder perforation after the transobturator tape procedure (p = 0.001). The rate of urinary retention in the tension-free vaginal tape group was significantly higher than that in the transobturator tape group (15.1% vs 6.6%, p = 0.004). The overall cure rate was significantly higher in the tension-free vaginal tape group than in the transobturator tape group (92.1% vs 84.9%, p = 0.015). On multivariate analysis 4 variables were independent risk factors for persistent stress urinary incontinence, that is comorbid disease (OR 2.37, 95% CI 1.26-4.47, p = 0.008), urge urinary incontinence (OR 1.95, 95% CI 1.02-3.74, p = 0.044), severe grade of cystocele (OR 2.73, 95% CI 1.43-5.20, p = 0.002) and transobturator tape procedure (OR 2.87, 95% CI 1.50-5.47, p = 0.001).
The cure rates in women with urinary incontinence are not similar after tension-free vaginal tape and transobturator tape procedures. Our findings suggest that characteristics including the type of procedure, comorbid diseases, mixed urinary incontinence and severe grade cystocele should be considered high risk factors for persistent stress urinary incontinence in these patients.
我们评估了尿失禁女性在无张力阴道吊带术或经闭孔吊带术后至少6个月的治疗结果，并确定了预测持续性压力性尿失禁的因素。
本研究共纳入464名年龄在28至80岁（平均年龄56岁）的女性。无张力阴道吊带术（252例）和经闭孔吊带术（212例）均由同一位外科医生实施。平均随访时间为10.8个月（范围6至52个月）。
无张力阴道吊带组有12例患者（4.8%）出现膀胱穿孔，而经闭孔吊带术后未出现膀胱穿孔（p = 0.001）。无张力阴道吊带组的尿潴留发生率显著高于经闭孔吊带组（15.1%对6.6%，p = 0.004）。无张力阴道吊带组的总体治愈率显著高于经闭孔吊带组（92.1%对84.9%，p = 0.015）。多因素分析显示，有4个变量是持续性压力性尿失禁的独立危险因素，即合并疾病（OR 2.37，95%CI 1.26 - 4.47，p = 0.008）、急迫性尿失禁（OR 1.95，95%CI 1.02 - 3.74，p = 0.044）、重度膀胱膨出（OR 2.73，95%CI 1.43 - 5.20，p = 0.002）和经闭孔吊带术（OR 2.87，95%CI 1.50 - 5.47，p = 0.001）。
无张力阴道吊带术和经闭孔吊带术后尿失禁女性的治愈率不相似。我们的研究结果表明，手术类型、合并疾病、混合性尿失禁和重度膀胱膨出等特征应被视为这些患者持续性压力性尿失禁的高危因素。
