Bogusiewicz Michał, Monist Marta, Gałczyński Krzysztof, Woźniak Magdalena, Wieczorek Andrzej P, Rechberger Tomasz
2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland,
World J Urol. 2014 Dec;32(6):1605-11. doi: 10.1007/s00345-014-1261-1. Epub 2014 Feb 17.
To investigate whether the position of the tape under the urethra may influence 'outside-in' transobturator sling (TOT) outcome.
The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment.
Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40-70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results.
The highest failure rate for 'outside-in' TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.
探讨尿道下方吊带的位置是否会影响经闭孔外向内吊带术（TOT）的疗效。
本研究纳入了141例因临床及尿动力学检查证实为压力性尿失禁而接受TOT手术的女性患者。患者出院前采用经阴道双平面探头进行术后超声检查。所获得的测量结果描述了吊带相对于尿道和耻骨联合的位置，以及前间隙的解剖关系。
96例（68.1%）患者治愈，27例（19.1%）显著改善，18例（12.7%）手术失败。尿道中段（尿道长度的第40至70百分位数）或尿道远端（>第70百分位数）下方的吊带位置，其治疗效果（治愈率分别为67.1%和82.4%）优于膀胱颈附近（<第40百分位数）的位置（治愈率为21.4%，p = 0.0015和p < 0.001）。然而，当吊带位于尿道远端下方时，失败风险最低。其他超声检查结果与治疗效果无关。
经闭孔外向内TOT手术失败率最高与尿道近端三分之一下方吊带的位置有关。尿道中段和远端均可视为经闭孔吊带放置的目标部位。
