Păun I, Mogoş D, Păun Mariana, Ciovică V, Florescu M, Teodorescu M, Picu Mirela, Dumitrelea D, Muşat S, Cotîrţă Irina, Mogoş D L
Clinica Chirurgie IV-Spitalul Clinic C. F. Craiova.
Chirurgia (Bucur). 2007 Nov-Dec;102(6):693-8.
The paper analyses the incidence, diagnosis and treatment options available for stress urinary incontinence (SUI) in women with pelvic floor dysfunction admitted to Craiova's Surgery Clinic IV.
This is a retrospective 10-year study comprising a surgical cohort of 420 patients with significant enough to alter quality of life SUI associated to ureterocele and cystocele and in 353 cases with rectocele too. The highest incidence of SUI was encountered between 50 and 59 years of age (range 39 - 81 years). In 21 of this case series the diagnosis of SUI was established soon after the surgical repair of the urethro-cystocele. The diagnosis of SUI was based on careful history and physical examination with emphasis on the gynecologic survey of the abdomen and pelvis but in the absence (for objective reasons) of urodynamic testing which is especially useful for SUI pathophysiological evaluation and thus surgery success rate prediction. All our 420 severe SUI associated with vaginal wall hernias underwent surgical treatment by either open Burch retropubic urethropexy or anterior colporraphy.
Among anterior colporraphy treated patients SUI persisted in 19.3% of the cases (33 patients). Complications of Burch urethropexy procedure (despite its high ability for cure) in our case series include: urinary retention, hemorrhage into the space of Retzius, intraoperative injury to the bladder and long-term postoperative incisional hernia. Moreover, 5 patients (2%) of the group who underwent Burch operation were readmitted with recurrent urinary incontinence between 2 and 6 months after the aforementioned surgical intervention despite its good anatomical results in all of these cases.
SUI is a prevalent disorder of women that can be diagnosed easily with history and physical exam. If symptoms persist and severely affect quality of life, despite modern noninvasive treatments, several surgical procedures are now available.
本文分析了克拉约瓦第四外科诊所收治的盆底功能障碍女性压力性尿失禁（SUI）的发病率、诊断方法及可用的治疗方案。
这是一项为期10年的回顾性研究，纳入了420例因输尿管膨出和膀胱膨出导致SUI且严重影响生活质量的手术队列患者，其中353例还伴有直肠膨出。SUI发病率最高的年龄段为50至59岁（年龄范围39 - 81岁）。在该病例系列中，有21例在尿道膀胱膨出手术修复后不久确诊为SUI。SUI的诊断基于详细的病史和体格检查，重点是腹部和盆腔的妇科检查，但由于客观原因未进行尿动力学检查，而尿动力学检查对SUI的病理生理评估及手术成功率预测尤为有用。我们所有420例与阴道壁疝相关的严重SUI患者均接受了开放式耻骨后尿道悬吊术或前路阴道修补术。
在前路阴道修补术治疗的患者中，19.3%（33例）的患者SUI持续存在。在我们的病例系列中，耻骨后尿道悬吊术（尽管其治愈率较高）的并发症包括：尿潴留、耻骨后间隙出血、术中膀胱损伤以及术后长期切口疝。此外，尽管上述手术干预后所有病例的解剖结果良好，但接受耻骨后手术的患者中有5例（2%）在术后2至6个月因复发性尿失禁再次入院。
SUI是一种常见的女性疾病，通过病史和体格检查易于诊断。如果症状持续且严重影响生活质量，尽管有现代非侵入性治疗方法，但现在仍有几种手术方法可供选择。
