Zengin Kursat, Kara Mustafa, Tanik Serhat, Sertcelik Memduh N, Eraslan Asir
Department of Urology, Bozok University Medical Faculty, Yozgat, Turkey.
Department of Obstetrics and Gynecology, Bozok University Medical Faculty, Yozgat, Turkey.
Adv Clin Exp Med. 2015 Sep-Oct;24(5):851-5. doi: 10.17219/acem/60568.
Urinary incontinence is a significant medico-social problem and its incidence increases up to 70% in the postmenopausal period.
We aimed to compare the efficacy and safety of transobturator adjustable tape (TOT) and mini sling in female urinary incontinence.
A total of 69 patients were included in the study. Single surgeon applied TOT (n=56 with ISD) or 13 mini sling (n=13 with ISD). Patients were considered to have ISD identified by a Valsalva leak point pressure (VLPP) measurement<60 cm H2O with a volume of 150 mL in the bladder or by a maximum urethral closure pressure (MUCP) measurement<20 cm H2O with a volume of 200 mL in the bladder. The mean follow-up period was 25 months for TOT group and 24 months for mini sling group (p=0.72).
The cough test was negative in 48 of TOT group (86%) and 11 of mini sling group (84.6%). ICIQ-SF scores for the median value decreased from 14 (11-21) preoperatively to 3 (0-9) postoperatively (p<0.05) in the TOT group, and 15 (12-23) preoperatively to 4 (0-10) postoperatively (p<0.05) in the mini sling group. The difference in the decrease of the score between two groups was not statistically significant (p=0.42). There was not any significant complication to note. The mean hospital stay for TOT group was 2.1 days (1-5), and 1.4 days (1-3) for mini sling group (p=0.12). Operation time was was significantly lower in mini-sling group than TOT group (11.6 vs. 18.4, p<0.01).
Both TOT and mini-sling procedures are successful and safe procedures in the treatment of female stress urinary incontinence with ISD.
尿失禁是一个重大的医学社会问题，在绝经后期其发病率高达70%。
我们旨在比较经闭孔可调节吊带术（TOT）和迷你吊带术治疗女性尿失禁的疗效和安全性。
本研究共纳入69例患者。由单一外科医生实施TOT（56例合并内在括约肌缺陷[ISD]）或13例迷你吊带术（13例合并ISD）。通过膀胱内150 mL容量时的瓦尔萨尔瓦漏尿点压力（VLPP）测量<60 cm H₂O或膀胱内200 mL容量时的最大尿道闭合压力（MUCP）测量<20 cm H₂O来确定患者存在ISD。TOT组的平均随访期为25个月，迷你吊带术组为24个月（p = 0.72）。
TOT组48例（86%）咳嗽试验为阴性，迷你吊带术组11例（84.6%）咳嗽试验为阴性。TOT组ICIQ - SF评分中位数从术前的14（11 - 21）降至术后的3（0 - 9）（p < 0.05），迷你吊带术组从术前的15（12 - 23）降至术后的4（0 - 10）（p < 0.05）。两组评分下降的差异无统计学意义（p = 0.42）。未发现任何显著并发症。TOT组的平均住院时间为2.1天（1 - 5天），迷你吊带术组为1.4天（1 - 3天）（p = 0.12）。迷你吊带术组的手术时间显著低于TOT组（11.6对18.4，p < 0.01）。
TOT和迷你吊带术在治疗合并ISD的女性压力性尿失禁方面都是成功且安全的手术。
