Chen Zhong, Chen Yuan, Du Guang-Hui, Yuan Xiao-yi, Wu Jia, Zeng Xiao-yong, Hu Zhi-quan, Cai Dan, Yang Wei-min
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techology, Wuhan 430030.
Urologia. 2010 Jan-Mar;77(1):37-41; discussion 42.
A study was conducted to compare the efficacy and complications of tension-free vaginal tape (TVT), transobturator vaginal tape inside-out TVT-O and transobturator vaginal tape out-inside (TOT) procedures for the surgical treatment of female stress urinary incontinence SUI.
This study is a prospective randomized trial involving 187 women with primary SUI; 77 received TVT, 65 received TVT-O, and 45 patients were treated with TVT-O between June 2002 and December 2009. Before the operation, a complete medical history was taken and a gynecologic examination was performed, including subjective symptoms, history and urodynamic studies. Postoperative data included mean operation time, days of hospitalization, postoperative complications and efficacy evaluation. Therapeutic effect was assessed by presence or absence of incontinence when abdominal pressure increased.
The history, physical examination and urodynamic studies among the three groups have no significant difference (P>0.05). The total cure rate was 91.4%. The cure rate in TVT, TVT-O and TOT groups were 90.9%, 92.3% and 91.1%, respectively. There was no significant difference (P>0.05). Mean operative time showed no significant difference between TVT-O and TOT groups, but both were significantly shorter than TVT group (26.90±16.80, 20.00±13.50 vs 48.20±21.90). The mean postoperative hospital stay showed no significant difference between TVT and TVT-O groups, but both groups were significantly longer than TOT group. Mean postoperative hospital stay of TVT, TVT-O and TOT were 5.00±2.40 days, 4.00±2.20 days and 2.30±0.80 days, respectively. The complication rate in TVT, TVT-O and TOT groups was 15.60%, 9.20% and 8.90%, respectively. In TVT group, 4 patients experienced bladder perforation, postoperative dysuria or retention occurred in 7 cases and was cured by urethral dilation, hematomas of retropubic space in 1 patient. No bladder injury occurred in TVT-O and TOT group, 3 patients had postoperative dysuria or retention and 3 patients had transient dysfunction of both lower limbs postoperatively in TVT-O group, 2 patients had postoperative dysuria or retention and 2 patients had transient dysfunction of both lower limbs postoperatively in TOT group.
The three tension-free urethral suspension techniques have similar efficacy, all of them are safe and effective procedures for the treatment of female SUI. Compared with TVT, TVT-O and TOT are simpler, less invasive and have fewer complications.
开展一项研究，比较无张力阴道吊带术（TVT）、经闭孔阴道吊带术（TVT-O）及经闭孔阴道吊带术（TOT）治疗女性压力性尿失禁（SUI）的疗效及并发症。
本研究为前瞻性随机试验，纳入187例原发性SUI女性患者；2002年6月至2009年12月期间，77例接受TVT治疗，65例接受TVT-O治疗，45例接受TOT治疗。术前，记录完整病史并进行妇科检查，包括主观症状、病史及尿动力学研究。术后数据包括平均手术时间、住院天数、术后并发症及疗效评估。通过增加腹压时有无尿失禁评估治疗效果。
三组患者的病史、体格检查及尿动力学研究无显著差异（P>0.05）。总治愈率为91.4%。TVT组、TVT-O组和TOT组的治愈率分别为90.9%、92.3%和91.1%。无显著差异（P>0.05）。TVT-O组和TOT组的平均手术时间无显著差异，但均显著短于TVT组（26.90±16.80，20.00±13.50 vs 48.20±21.90）。TVT组和TVT-O组的平均术后住院时间无显著差异，但均显著长于TOT组。TVT组、TVT-O组和TOT组的平均术后住院时间分别为5.00±2.40天、4.00±2.20天和2.30±0.80天。TVT组、TVT-O组和TOT组的并发症发生率分别为15.60%、9.20%和8.90%。TVT组中，4例发生膀胱穿孔，7例出现术后排尿困难或尿潴留，经尿道扩张治愈，1例出现耻骨后间隙血肿。TVT-O组和TOT组未发生膀胱损伤，TVT-O组3例出现术后排尿困难或尿潴留，3例术后出现双下肢短暂功能障碍，TOT组2例出现术后排尿困难或尿潴留，2例术后出现双下肢短暂功能障碍。
三种无张力尿道悬吊技术疗效相似，均是治疗女性SUI的安全有效方法。与TVT相比，TVT-O和TOT操作更简单，创伤更小，并发症更少。
