Penttinen J, Kaar K, Kauppila A
Department of Obstetrics and Gynaecology, University of Oulu, Finland.
Gynecol Obstet Invest. 1989;28(2):101-5. doi: 10.1159/000293525.
The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.
本研究旨在评估阴道旁悬吊术治疗无子宫阴道脱垂的压力性尿失禁及膀胱颈悬吊术治疗有子宫阴道脱垂患者的临床实用性。对29例患者实施改良式Burch阴道旁悬吊术，对19例患者实施改良式Raz膀胱颈悬吊术。在手术前及术后8 - 12个月对患者进行临床及尿动力学检查。阴道旁悬吊术组所有患者术后均认为自己完全控尿。膀胱颈悬吊术组相应比例为58%，另外21%有改善，21%失败。尿动力学方面，阴道旁悬吊术的治愈率（压力状态下尿道闭合压阳性）为100%，膀胱颈悬吊术为79%。阴道旁悬吊术后，压力状态下尿道闭合压及压力传递率显著增加，而成功的膀胱颈悬吊术仅增加压力状态下尿道闭合压。失败的膀胱颈悬吊术未引起任何尿动力学变化。目前的数据证实，Burch阴道旁悬吊术对无同时合并子宫阴道脱垂的女性压力性尿失禁有效，而改良式Raz技术的膀胱颈悬吊术对于子宫阴道脱垂患者的压力性尿失禁治疗似乎并非最佳选择。
