Debodinance P, Lagrange E, Amblard J, Lenoble C, Lucot J-P, Villet R, Cosson M, Jacquetin B
Département gynécologie obstétrique, centre hospitalier Dunkerque, 43, rue des Pinsons, 59430 Saint-Pol-sur-Mer, France.
J Gynecol Obstet Biol Reprod (Paris). 2008 May;37(3):229-36. doi: 10.1016/j.jgyn.2008.01.008. Epub 2008 Mar 17.
To present a new minimal invasive suburethral tape device derivative of the classic TVT, to describe the technique of laying, to evaluate complications and results to short term.
Prospective multicentric study of 110 patients presenting a stress urinary incontinence and benefiting from the laying of TVT Secur without associated operation. The tape is identical to that old-fashioned retropubic and obturator TVT, smaller, laying in "U" or in "hammock" without orifice of exit, to avoid complications due to crossed spaces of the other techniques. The device and the technique of laying are described by authors. The originality of the TVT Secur resides in the mechanism of insertion of the tape to a metallic divice. All patients have been controlled at two months and complications with notably pains (quotation VAS) as well as objective results have been reported.
Pure and isolated stress urinary incontinence for 71 patients, mixed incontinence for 39 and sphincter deficient for 23. Preoperative urgency for 49 patients and dysuria for 10 of them. The method "hammock" has been used in 85.5% of cases. The type of anaesthesia has been pure local for 69.1% (0 to 98.8% for the different centers) with an average operative time of 8'30". Under local anaesthesia, the average per operative pain was quoted 2.8/10, and 0.7 at the end of intervention. Peroperative complications have revealed a wound of bladder, a vaginal wound and four bleeding of more than 100ml. In immediate continuations a total retention yielding to 24h and 13 postmicturition residual between 100 and 200ml have been mentioned. At two months, authors have observed the following: de novo urgency in 19.6%, de novo dysuria in 13.2%, one tape exposition, one granuloma, one urinary infection and seven perceptible lateral cords without pain. Thirteen patients have signalled to have had moderated pains on a duration of four to 30 days. Early objective results are globally 70.4% of dry patients (83% for pure isolated SUI, 72.2% for SUI with deficient sphincter, 50% for mixed incontinence). The pure local anaesthesia was recommended by 98% of patients.
The diminution of complications ahead not to be made to the detriment of results, it is necessary to envisage multicentric studies with standardized modifications. The indications of this new device will have to be defined.
介绍一种源自经典经阴道无张力尿道中段悬吊带术（TVT）的新型微创尿道下悬带装置，描述放置技术，评估短期并发症及效果。
对110例压力性尿失禁患者进行前瞻性多中心研究，这些患者接受了TVT Secur放置术且未进行相关联合手术。该吊带与老式耻骨后和闭孔TVT相同，但尺寸更小，呈“U”形或“吊床”形放置且无出口孔，以避免其他技术因交叉间隙导致的并发症。作者描述了该装置及放置技术。TVT Secur的独特之处在于吊带插入金属装置的机制。所有患者在术后两个月进行了复查，报告了包括疼痛（视觉模拟评分法评分）在内的并发症以及客观效果。
71例为单纯性压力性尿失禁，39例为混合性尿失禁，23例为括约肌功能不全。49例患者术前有尿急症状，其中10例有排尿困难。85.5%的病例采用了“吊床”法。69.1%的患者采用单纯局部麻醉（不同中心为0至98.8%），平均手术时间为8分30秒。在局部麻醉下，术中平均疼痛评分为2.8/10，术后为0.7。术中并发症包括膀胱损伤、阴道损伤以及4例出血量超过100ml的出血。术后即刻出现24小时完全尿潴留，13例患者排尿后残余尿量在100至200ml之间。术后两个月，作者观察到以下情况：新发尿急19.6%，新发排尿困难13.2%，1例吊带外露，1例肉芽肿，1例泌尿系统感染，7例可触及侧索但无疼痛。13例患者表示有持续4至30天的中度疼痛。早期客观效果总体上70.4%的患者实现了干爽（单纯性压力性尿失禁患者为83%，括约肌功能不全的压力性尿失禁患者为72.2%，混合性尿失禁患者为50%）。98%的患者推荐单纯局部麻醉。
在不影响效果的前提下减少并发症，有必要开展标准化改良的多中心研究。这种新装置的适应证有待明确。
