Cordeiro Alexandra, Lermann Rita, Grilo Isabel, Martins Amália, Moniz Luís
Serviço de Ginecologia, Maternidade Alfredo da Costa, Lisboa.
Acta Med Port. 2010 Jul-Aug;23(4):589-96. Epub 2010 Jul 30.
Minimal invasive surgical treatment of female stress urinary incontinence with suburethral transobturator tapes is completely accepted nowadays. The purpose of this study is to evaluate the efficacy and security of these suburethral tapes, comparing the outside-in to the inside-out approach.
We performed a retrospective study of 298 patients with stress urinary incontinence diagnosis that were submitted to transobturator surgery between 2003 and 2006. From these patients 113 women underwent outside-in approach and 185 patients had inside-out approach.
The mean-age of the patients was 57.2 +/- 10.3 years-old and 69.1% were in the post-menopausal period. Mean parity was 2.2 +/- 1.1. The outside-in approach was performed more frequently in association with other(s) pelvic floor surgery(ies) (83.2% versus 37.8% for the inside-out technique). The mean follow-up duration was of 14.35 +/- 13.75 months in those patients who had a transobturator outside-in technique and of 11.79 +/- 10.39 months in the inside-out group. In respect to the efficacy, results were identical in the two groups with cure and cure or improvement rates respectively of 76.9% and 92.9% in the outside-in group and of 82.7% and 93.5% in the inside-out group (differences not significative). Regarding mean procedure duration, when it was performed isolated, we had a significant lower duration in patients submitted to inside-out technique (14.77 +/- 5.37 minutes versus 21.21 +/- 7.48 minutes, p < 0.05). The post-operative rates of de novo urge incontinence and mesh erosions were identical in the two groups, however microporous tapes had more erosions than macroporous ones (p < 0.05).
The transobturator suburethral tapes are effective and safe for the stress urinary incontinence treatment. We had elevated cure and improvement rates with no significant differences in regard to performed procedure. The inside-out technique is significantly associated to a lower operative duration.
目前，采用经闭孔尿道下带进行女性压力性尿失禁的微创手术治疗已被完全接受。本研究的目的是评估这些尿道下带的疗效和安全性，比较由外向内法和由内向外法。
我们对2003年至2006年间接受经闭孔手术的298例压力性尿失禁患者进行了回顾性研究。其中113例女性采用由外向内法，185例患者采用由内向外法。
患者的平均年龄为57.2±10.3岁，69.1%处于绝经后期。平均产次为2.2±1.1。由外向内法更常与其他盆底手术联合进行（83.2%，而由内向外技术为37.8%）。采用经闭孔由外向内技术的患者平均随访时间为14.35±13.75个月，由内向外组为11.79±10.39个月。在疗效方面，两组结果相同，由外向内组的治愈率和治愈或改善率分别为76.9%和92.9%，由内向外组为82.7%和93.5%（差异无统计学意义）。关于平均手术时间，当单独进行时，采用由内向外技术的患者手术时间明显较短（14.77±5.37分钟对21.21±7.48分钟，p<0.05）。两组术后新发急迫性尿失禁和网片侵蚀率相同，然而微孔带的侵蚀比大孔带更多（p<0.05）。
经闭孔尿道下带治疗压力性尿失禁有效且安全。我们有较高的治愈率和改善率，在手术操作方面无显著差异。由内向外技术与较短的手术时间显著相关。
