Paganotto M C, Amadori L, Di Donato N, Mauloni M, Busacchi P
Department of Gynecology and Pathophysiology of Human Reproduction, Policlinico S. Orsola-Malpighi University Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Minerva Ginecol. 2013 Jun;65(3):319-26.
The aim of this paper was to assess the feasibility and utility of adding a preventive trans obturatory tape (TOT) during the same intervention for anterior prolapse repair, in patients with masked urinary incontinence and massive cystocele.
A retrospective trial was conducted in a Tertiary care University Hospital. Ninety-nine women with a massive cystocele (Ba ≥2 cm of pelvic organ prolapse quantification) and an occult stress urinary incontinence were recruited from 2004 to 2010: 53 women were subjected to an anterior fascial reconstruction alone while 46 underwent the same intervention with the addition of TOT. Patients were also asked to rate their overall quality of life, using the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality Of Life (ICIQ-LUTSqol). All patients were assessed at one, six, twelve and twenty-four months of follow-up. Statistical analysis was performed with SPSS 15.0 software; SPSS inc., Chicago IL, USA was performed using the Chi-square test with Fisher's post-hoc correction.
At 24 month follow-up the rate of appearance of stress urinary incontinence at the urogynecological examination, was higher in the group without TOT (81% vs. 19%, P=0.004). In terms of overall quality of life, significantly higher rates of satisfaction have been reported by the group treated with additional TOT (P=0.006).
The addition of TOT during the anterior prolapse correction seems to give a greater durability to the correction, resulting, in the long term, in a lower rate of urinary symptoms onset (first latency) and in a better quality of life compared to the traditional anterior colporrhaphy alone.
本文旨在评估在同一手术中增加预防性经闭孔尿道中段吊带术（TOT）用于治疗隐匿性尿失禁和巨大膀胱膨出患者的前盆腔脏器脱垂修复的可行性和实用性。
在一所三级护理大学医院进行了一项回顾性试验试验。2004年至2010年招募了99例患有巨大膀胱膨出（盆腔器官脱垂定量法中Ba≥2cm）和隐匿性压力性尿失禁的女性：53例女性仅接受前壁筋膜重建术，而46例在相同手术中加用了TOT。还要求患者使用国际尿失禁咨询委员会下尿路症状生活质量模块问卷（ICIQ-LUTSqol）对其总体生活质量进行评分。所有患者在术后1个月、6个月、12个月和24个月进行随访评估。使用SPSS 15.0软件进行统计分析；美国伊利诺伊州芝加哥的SPSS公司使用卡方检验及费舍尔事后校正进行分析。
在24个月的随访中，未使用TOT组在泌尿妇科检查时压力性尿失禁的发生率更高（81%对19%，P=0.004）。在总体生活质量方面，加用TOT治疗组报告的满意度显著更高（P=0.006）。
在前盆腔脏器脱垂修复术中加用TOT似乎能使修复效果更持久，从长期来看，与单纯传统的阴道前壁修补术相比，能降低尿路症状的发生率（首次出现时间），并改善生活质量。
