Kociszewski Jacek, Rautenberg Oliver, Perucchini Daniele, Eberhard Jakob, Geissbühler Verena, Hilgers Reinhard, Viereck Volker
Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Huspe, Hagen, Germany.
Neurourol Urodyn. 2008;27(6):485-90. doi: 10.1002/nau.20556.
To investigate tension-free vaginal tape (TVT) position and shape using ultrasound (US) and correlate the findings to outcome.
The results of TVT surgery were investigated in 72 women with urodynamic stress urinary incontinence. The main outcome parameters were US tape position in relation to the urethra and dynamic changes in TVT shape at rest and during straining.
Sixty-two patients (86%) were continent, 6 (8%) significantly improved, and the operation failed in four cases (6%). The median tape position was at 66% of the urethral length measured by US. The median tape-urethra-lumen distance was 3.8 mm at rest. Tape placement in the upper or lower quarter of the urethra was associated with a higher failure rate. Tapes positioned less than 3 mm from the urethra significantly increased postoperative complications (P < 0.0001). The tape was flat at rest and curved during straining in 44 (61%) patients; 98% (43/44) of these women were continent after surgery. An unchanged tape shape was associated with a poorer outcome (P = 0.00038). Patients with a flat tape at rest and during straining failed in 25% and patients with a permanent curved shape in 10%.
TVT position relative to the patient's urethra seems to play a role in treatment outcome. Outcome was best in patients with dynamic change in tape shape during straining and location of the tape at the junction between the lower and middle urethra and at least 3 mm from the urethral lumen.
使用超声（US）研究无张力阴道吊带术（TVT）的位置和形态，并将研究结果与治疗效果相关联。
对72例存在尿动力学压力性尿失禁的女性进行TVT手术结果研究。主要观察指标为TVT吊带相对于尿道的位置以及静息和用力时TVT形态的动态变化。
62例患者（86%）尿失禁症状消失，6例（8%）有显著改善，4例（6%）手术失败。吊带位置的中位数为经超声测量的尿道长度的66%。静息时吊带与尿道管腔的距离中位数为3.8毫米。吊带置于尿道上四分位或下四分位与较高的失败率相关。吊带与尿道距离小于3毫米会显著增加术后并发症（P < 0.0001）。44例（61%）患者静息时吊带平坦，用力时弯曲；其中98%（43/44）的女性术后尿失禁症状消失。吊带形态无变化与较差的治疗效果相关（P = 0.00038）。静息和用力时吊带均平坦的患者手术失败率为25%，吊带永久弯曲的患者手术失败率为10%。
TVT相对于患者尿道的位置似乎对治疗效果有影响。用力时吊带形态有动态变化、吊带位于尿道下四分位与中四分位交界处且距尿道管腔至少3毫米的患者治疗效果最佳。
