Lo Tsia-Shu, Jaili Sukanda, Tan Yiap Loong, Wu Pei-Ying
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, 222, Maijin Road, Keelung, Taiwan, Republic of China.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center, Taipei, Taiwan, Republic of China.
Int Urogynecol J. 2016 Nov;27(11):1653-1659. doi: 10.1007/s00192-016-3019-3. Epub 2016 Apr 16.
We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term.
We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a Monarc TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3 years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2 g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival.
Sixty patients were enrolled, and 56 were evaluated at 5 years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9 min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6 months. At 5 years of follow-up, objective and subjective cure rates were 89.3 % and 87.5 %, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer.
Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.
我们假设经闭孔尿道中段悬吊带术（TOT）在长期治疗尿动力学压力性尿失禁方面是安全且有效的。
我们对确诊为尿动力学压力性尿失禁（USI）的患者进行了一项前瞻性研究，这些患者于2006年2月至2009年3月在一家三级中心接受了Monarc TOT手术，未同时进行其他外科手术。术后1年和3年进行尿动力学检查。主观评估包括尿失禁影响问卷（IIQ - 7）、排尿困难问卷（UDI - 6）以及盆腔器官脱垂/尿失禁性功能问卷（PISQ - 12）。客观治愈定义为在激发性充盈膀胱测压和/或1小时垫试验中无明显漏尿（<2克）。主观治愈基于UDI - 6中问题3的阴性回答。应用配对样本t检验、卡方检验和Fisher精确检验；p < 0.05被认为具有统计学意义。采用对数秩检验比较无事件生存率。
共纳入60例患者，56例在术后5年接受评估。大多数患者为中年、绝经后且超重。平均手术时间为31.1±8.9分钟，术中并发症轻微，中位随访时间为80.3±9.6个月。随访5年时，客观治愈率和主观治愈率分别为89.3%和87.5%。未发现与网片相关的并发症。1例患者需要重复进行尿道中段吊带手术，1例患者分别患有膀胱癌和肠癌。
Monarc TOT在压力性尿失禁的短期和长期治疗中是安全的，并保持了较高的治愈率。
