Long Cheng-Yu, Hsu Chun-Shuo, Lo Tsia-Shu, Liu Cheng-Min, Chen Yung-Hung, Tsai Eing-Mei
Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Acta Obstet Gynecol Scand. 2008;87(1):116-21. doi: 10.1080/00016340701797765.
The purpose of this study was to perform an ultrasonographic comparison of tension-free vaginal tape (TVT) and the TVT-obturator (TVT-O) procedure in women with stress urinary incontinence (SUI).
We retrospectively reviewed 159 women with SUI undergoing either TVT (n=91) or TVT-O (n=68). All subjects underwent perineal ultrasonographies, pelvic examination, urinalyses, 1-h pad tests, multichannel urodynamic studies and a personal interview using the Bristol Female Lower Urinary Tract Symptoms Questionnaire before and 1 year after surgery.
At rest or during Valsalva, the middle of the TVT-O tape localised more distally than the TVT on ultrasound (p<0.01). A higher rate of urethral kinking during straining was observed in the TVT group compared with the TVT-O group after surgery (86.9 versus 23.9%, p<0.01). Mean operative time was significantly shorter in the TVT-O group (16.2 versus 28.6 min, p<0.01). The rate of objective cure was comparable for the TVT and TVT-O groups (94.5 versus 88.2%, p<0.05). However, subjective cure rate was significantly lower for the TVT-O than the TVT group (82.4 versus 93.4%, p=0.042). There was no statistical difference between the 2 groups regarding patient characteristics and complication rates.
TVT-O tape results in a less acute angle and localises to a more distal part of the urethra, resulting in less urethral compression and a lower rate of urethral dynamic kinking.
本研究旨在对压力性尿失禁（SUI）女性患者的无张力阴道吊带术（TVT）和经闭孔无张力阴道吊带术（TVT-O）进行超声比较。
我们回顾性分析了159例接受TVT（n = 91）或TVT-O（n = 68）治疗的SUI女性患者。所有受试者在手术前和术后1年接受了会阴超声检查、盆腔检查、尿液分析、1小时垫试验、多通道尿动力学研究以及使用布里斯托尔女性下尿路症状问卷进行的个人访谈。
在静息状态或瓦尔萨尔瓦动作期间，超声显示TVT-O吊带中部比TVT更位于尿道远端（p < 0.01）。术后TVT组与TVT-O组相比，用力时尿道扭结发生率更高（86.9%对23.9%，p < 0.01）。TVT-O组的平均手术时间明显更短（16.2分钟对28.6分钟，p < 0.01）。TVT组和TVT-O组的客观治愈率相当（94.5%对88.2%，p < 0.05）。然而，TVT-O组的主观治愈率明显低于TVT组（82.4%对93.4%，p = 0.042）。两组在患者特征和并发症发生率方面无统计学差异。
TVT-O吊带导致的角度较小，且位于尿道更远端，从而减少尿道压迫和尿道动态扭结发生率。
