Mourtzinos Arthur, Maher Mary Grey, Raz Shlomo, Rodríguez Larissa V
Institute of Urology, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, Massachusetts 01805, USA.
Urology. 2008 Nov;72(5):1044-8; discussion 1048-50. doi: 10.1016/j.urology.2008.05.061. Epub 2008 Sep 19.
Female patients with refractory stress urinary incontinence (SUI) are a unique surgical challenge. They undergo multiple surgical procedures and eventually are left with urethral closure and continent diversion as their final option. We previously presented our initial experience of a technique that provides circumferential coaptation of the urethra in patients with severe urethral incompetence due to neurologic injuries or congenital anomalies. This study expands on that experience and reports on the clinical and quality of life of patients after spiral sling placement in a defined population of patients with refractory SUI.
We prospectively evaluated 46 patients with refractory SUI who had undergone spiral sling placement. The surgical outcome was determined by clinical history and physical examination and, primarily, by patient self-assessment and included validated symptom, bother, and quality-of-life questionnaires.
Their mean age was 62 years. The mean follow-up was 15 months. At presentation, the patients had undergone a mean of 2.8 incontinence procedures and wore a mean of 5.5 pads daily. The mean pad use decreased to 1.3 pads daily (P <.05). Preoperatively, the mean severity and bother score from the SUI symptoms was 3.0 and 2.9, respectively (0, none; 3, severe). Postoperatively, these numbers decreased to 1.0 and 0.8 (P <.05). The mean overall improvement in symptoms was 82%. No perioperative complications developed. The procedure failed in 1 patient, who underwent urethral closure with urinary diversion. Two patients underwent repeat proximal spiral sling procedure.
The spiral sling is an effective salvage transvaginal procedure that can be considered for female patients with refractory SUI.
难治性压力性尿失禁（SUI）的女性患者是独特的手术挑战对象。她们接受了多次外科手术，最终尿道闭合和可控性尿流改道成为其最后的选择。我们之前介绍了一种技术的初步经验，该技术可使因神经损伤或先天性异常导致严重尿道功能不全的患者实现尿道的环形贴合。本研究拓展了该经验，并报告了在特定难治性SUI患者群体中放置螺旋吊带后患者的临床情况和生活质量。
我们前瞻性评估了46例接受螺旋吊带放置手术的难治性SUI患者。手术结果通过临床病史和体格检查确定，主要依据患者自我评估，包括经过验证的症状、困扰及生活质量问卷。
她们的平均年龄为62岁。平均随访时间为15个月。就诊时，患者平均接受过2.8次失禁手术，每天平均使用5.5片尿垫。尿垫平均使用量降至每天1.3片（P<.05）。术前，SUI症状的平均严重程度和困扰评分分别为3.0和2.9（0表示无，3表示严重）。术后，这些数字降至1.0和0.8（P<.05）。症状的平均总体改善率为82%。未发生围手术期并发症。1例患者手术失败，该患者接受了尿道闭合及尿流改道手术。2例患者接受了近端螺旋吊带重复手术。
螺旋吊带是一种有效的经阴道挽救性手术，可用于难治性SUI的女性患者。
