Park Jae-Joon, Lee Hyung Ho, Kim Young Sig
Department of Urology, Severance Hospital, Seoul, Korea.
NHIS Ilsan Hospital, Goyang, Korea.
Chonnam Med J. 2014 Dec;50(3):91-5. doi: 10.4068/cmj.2014.50.3.91. Epub 2014 Dec 17.
Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.
此前报道的大多数术中激发试验是在调整补片后进行，以确认无尿液漏出。相反，我们的试验是在调整补片之前进行，通过观察尿液漏出模式来控制吊带张力。我们研究了该方法对经闭孔尿道中段吊带术（TOT）成功率的影响。共纳入96例患者：47例患者未进行术中试验接受TOT手术（第一组），49例患者进行试验后接受TOT手术（第二组）。试验期间用至少300ml生理盐水充盈膀胱。通过咳嗽或耻骨上区手动施压观察补片调整前尿液漏出模式后，我们控制补片张力。在未进行术中试验的第一组中，瓦尔萨尔瓦漏点压、咳嗽漏点压、术前和术后最大尿流率（Qmax）以及排尿后残余尿量（PVR）分别为86.46cmH₂O、101.91cmH₂O、20.82ml/s、22.74ml/s、19.77ml和45.98ml。术后与术前Qmax和PVR的变化分别为1.92ml/s和26.21ml。在进行试验的第二组中，相应结果分别为85.50cmH₂O、100.45cmH₂O、25.60ml/s、26.90ml/s、17.16ml和29.67ml。术后与术前Qmax和PVR的变化分别为1.3ml/s和12.51ml。两组在任何变量上均无显著差异。在第一组中，治愈率和改善率分别为70.2%和27.7%。在第二组中，这两个率分别为91.8%和8.2%。第二组的成功率显著高于第一组（p值 = 0.011）。在单变量逻辑回归分析中，就治愈率而言，第二组的优势比（4.771）高于第一组，且第二组的成功率高于第一组（p值 = 0.011）。在多变量逻辑回归分析中，在计算变量（即年龄、高血压、术前Qmax和PVR）的情况下，就治愈率而言，第二组的优势比（4.700）高于第一组，且经证实第二组的治愈率显著高于第一组（p值 = 0.019）。我们认为我们的试验是确认吊带是否施加了足够张力的有效方法。我们的方法具有一些优势，即外科医生在观察尿液漏出程度和模式后可以控制和调整补片张力。
