Royal National Orthopaedic Hospital, Stanmore & Institute of Urology, UCL, London, UK.
BJU Int. 2010 Sep;106(6):827-30. doi: 10.1111/j.1464-410X.2010.09203.x. Epub 2010 Feb 3.
To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction.
Twelve women (mean age 53.3 years, range 41-80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment.
The mean (range) follow-up was 10 (8.5-12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up.
In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes.
评估经阴道无张力悬吊带（TVT）治疗伴有神经原性膀胱功能障碍的女性压力性尿失禁（SUI）的长期安全性和疗效。
1997 年 11 月至 2000 年 12 月，一位专家级神经泌尿科医生在一家机构中对 12 例伴有神经原性膀胱功能障碍和 SUI 的女性（平均年龄 53.3 岁，范围 41-80 岁）采用 TVT 进行治疗，这些患者通过视频尿动力学（VCMG）确诊。在长期的 SUI 临床随访中，评估了患者的病历、临床年度随访和术后 VCMG，以及尿失禁影响问卷（IIQ）表格（尿困扰问卷和 IIQ-7），同时评估了健康相关生活质量。SUI 的治愈定义为体力活动时无尿液流失、术后 VCMG 证实以及临床评估。
平均（范围）随访时间为 10（8.5-12）年。在 TVT 置入前，9 例患者使用清洁间歇性自家导尿，之后继续使用。10 年随访时，1 例患者死亡（TVT 最初失败），2 例患者在术后 5 年失访，但截至 5 年时，她们没有报告 UI，VCMG 也未显示 SUI。9 例患者中有 7 例完全干燥，2 例改善且对每天使用 1 或 2 片护垫感到满意。2 例患者 VCMG 证实存在神经原性逼尿肌过度活动，但无 SUI 证据。1 例患者术后出现短暂性尿潴留，需留置导尿管，1 例患者膀胱损伤需留置导尿管 5 天，但在随访过程中未报告尿道侵蚀。
对于继发于各种脊髓病变的伴有神经原性膀胱功能障碍且需要确定性干预的 SUI 女性，应考虑 TVT 作为一种理想的治疗方法，其长期疗效非常好。
