Ümraniye Training and Research Hospital, Clinic of Urology, Istanbul, Turkey.
Urology. 2012 Aug;80(2):273-9. doi: 10.1016/j.urology.2012.03.064.
To evaluate our minimum 1.5-year results with "surgeon-tailored" polypropylene mesh (STPM) in stress urinary incontinence treatment and the impact of concomitant pelvic organ prolapse repair on functional outcomes.
All patients who were treated for stress urinary incontinence and pelvic organ prolapse using STPM between 2006 and 2010 were reviewed. Fifty-two patients received transobturator midurethral sling alone. Concomitant pelvic organ prolapse repair was performed in 74 (67 cystocele, 14 rectocele). Pre- and postoperative evaluation included subjective assessment of the impact of voiding and prolapse symptoms with International Consultation on Incontinence-Short Form and Prolapse Quality of Life (P-QOL) questionnaires, uroflowmetry, and urodynamic studies when necessary. Surgical outcomes at the last follow-up and complications were compared between the transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups.
One-hundred eighteen women were available for analysis. With a mean follow-up of 33.4 and 41.2 months for transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups, stress urinary incontinence was cured in 86.4% and 81.1% of the patients, respectively. Preoperative urge symptoms resolved in 53.8% and 62.5%, and de novo urge symptoms developed in 22% and 15% of patients with respect to study groups. Pelvic organ prolapse was cured in 98.6% patients, with a significant improvement in all domains of the P-QOL questionnaire at the last follow-up. Vaginal mesh erosions were detected in 11 (14.8%) patients with concomitant pelvic organ prolapse repair.
STPM may represent a cost-effective option for stress urinary incontinence treatment. Concomitant pelvic organ prolapse repair with STPM does not affect incontinence outcomes and provides high anatomic success and patient satisfaction in the long term. However, mesh-related complications with this approach is a major concern that deserves further investigation of risk factors and better definition of patient selection criteria.
评估我们使用“外科医生定制”聚丙烯网（STPM）治疗压力性尿失禁的至少 1.5 年结果，以及合并盆腔器官脱垂修复对功能结果的影响。
回顾 2006 年至 2010 年间使用 STPM 治疗压力性尿失禁和盆腔器官脱垂的所有患者。52 例患者单独接受经闭孔尿道中段吊带术。74 例（67 例膀胱膨出，14 例直肠膨出）患者同时行盆腔器官脱垂修复。术前和术后评估包括使用国际尿失禁咨询问卷-短表（ICIQ-SF）和盆腔器官脱垂生活质量问卷（P-QOL）评估排尿和脱垂症状的影响，尿流率和必要时行尿动力学研究。比较经闭孔尿道中段吊带术和经闭孔尿道中段吊带术+盆腔器官脱垂修复组的最后随访时的手术结果和并发症。
118 例女性可进行分析。经闭孔尿道中段吊带术和经闭孔尿道中段吊带术+盆腔器官脱垂修复组的平均随访时间分别为 33.4 和 41.2 个月，分别有 86.4%和 81.1%的患者压力性尿失禁治愈。术前急迫症状缓解率分别为 53.8%和 62.5%，研究组分别有 22%和 15%的患者新发急迫症状。盆腔器官脱垂治愈 98.6%的患者，P-QOL 问卷所有领域在最后随访时均显著改善。合并盆腔器官脱垂修复的 11 例（14.8%）患者检测到阴道网片侵蚀。
STPM 可能是治疗压力性尿失禁的一种具有成本效益的选择。STPM 联合治疗盆腔器官脱垂不会影响尿失禁结局，并提供长期高解剖成功率和患者满意度。然而，这种方法的网片相关并发症是一个主要关注点，值得进一步研究风险因素和更好地定义患者选择标准。
