Anast Jason W, Skolarus Ted A, Yan Yan, Klutke Carl G
Division of Urology, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
Can J Urol. 2008 Aug;15(4):4153-7.
The transobturator sling (TOS) is safe and effective for the treatment of female stress urinary incontinence (SUI). Controversy exists regarding its efficacy in patients with low valsalva leak point pressure (VLPP), a marker of intrinsic sphincter deficiency (ISD). We review our experience of TOS in the treatment of women with SUI and low VLPP.
Patients diagnosed with stress or mixed incontinence treated with TOS were identified by retrospective review. All procedures were performed with local anesthesia and intravenous sedation. Stress incontinence and VLPP were determined preoperatively with urodynamic testing. Chart review identified demographics, perioperative variables, complications, and subjective cure. Low VLPP was defined as VLPP less than 60 cm H2O.
From November 2003 to February 2006, 151 consecutive women underwent TOS. Twenty-seven patients were excluded who exhibited incontinence with cough but not valsalva on preoperative urodynamic testing. Of the remaining 124 patients, 29% had low VLPP and 71% had higher VLPP. There was no difference in subjective cure between patients with low (94%) and higher VLPP (84%) overall (p = 0.12) or in patients with 12 months or more of follow-up (93% versus 79%, p = 0.40). Patients with low VLPP were more likely to be older (p = 0.036), and have pure SUI (p = 0.019).
TOS is effective for patients with low VLPP. Women with SUI and ISD without a fixed urethra should be considered candidates for TOS. The use of intravenous sedation during sling placement allows the surgeon to perform an intraoperative cough test, permitting tensioning of the TOS in relation to the patient's ISD.
经闭孔尿道中段悬吊带术（TOS）治疗女性压力性尿失禁（SUI）安全有效。对于其在膀胱逼尿肌漏尿点压（VLPP）较低（内在括约肌缺陷（ISD）的一个指标）的患者中的疗效存在争议。我们回顾了我们使用TOS治疗SUI且VLPP较低的女性患者的经验。
通过回顾性分析确定接受TOS治疗的压力性或混合性尿失禁患者。所有手术均在局部麻醉和静脉镇静下进行。术前通过尿动力学检查确定压力性尿失禁和VLPP。病历回顾确定了人口统计学资料、围手术期变量、并发症和主观治愈情况。低VLPP定义为VLPP小于60 cm H2O。
2003年11月至2006年2月，151名连续女性接受了TOS。27例患者因术前尿动力学检查显示咳嗽时尿失禁但Valsalva动作时无尿失禁而被排除。在其余124例患者中，29%的患者VLPP较低，71%的患者VLPP较高。总体而言，VLPP较低（94%）和较高（84%）的患者主观治愈率无差异（p = 0.12）；在随访12个月或更长时间的患者中，主观治愈率也无差异（93%对79%，p = 0.40）。VLPP较低的患者年龄更大（p = 0.036），且更可能为单纯性SUI（p = 0.019）。
TOS对VLPP较低的患者有效。对于无固定尿道的SUI和ISD女性患者应考虑行TOS。在放置吊带期间使用静脉镇静可使外科医生进行术中咳嗽试验，从而根据患者的ISD调整TOS的张力。
