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评估TVT-Secur手术治疗女性压力性尿失禁的安全性和有效性。

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women.

作者信息

Sandhu J S, Karan S C, Maiti G D, Dudeja Puja

机构信息

Senior Advisor (Surgery and Urology), Command Hospital (Central Command), Lucknow, India.

Consultant (Surgery and Urology), Army Hospital (Research and Referral), New Delhi 110001, India.

出版信息

Med J Armed Forces India. 2017 Jan;73(1):36-41. doi: 10.1016/j.mjafi.2016.07.010. Epub 2016 Sep 5.

Abstract

BACKGROUND

The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women.

METHODS

20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year.

RESULTS

The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% ( = 1), urethral injury in 5% ( = 1) and urethral tape exposure in 10% ( = 2), at 3 months requiring tape sectioning.

CONCLUSIONS

These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

摘要

背景

印度中年女性压力性尿失禁(SUI)的患病率约为16%。经阴道无张力尿道中段悬吊带术(TVT)的应用彻底改变了SUI的外科治疗方法。经闭孔途径放置吊带的患者经常抱怨套管针插入部位持续的大腿疼痛。使用具有单个尿道下切口的微创吊带通过消除大腿切口减少了手术创伤,同时保持了传统TVT所达到的治愈率。本研究旨在测试微创TVT-Secur吊带置入术治疗女性SUI的有效性和安全性。

方法

20例压力性尿失禁女性患者植入TVT-Secur吊带并随访一年。

结果

一年后SUI的客观治愈率为85%。患者满意度以及泌尿生殖系统困扰量表(UDI-6)和尿失禁影响问卷-7(IIQ-7)的尿失禁特异性生活质量评分的改善在95%和99%置信水平上具有统计学意义。无大腿疼痛主诉;然而,3个月时出现术中并发症,膀胱穿孔5%(n = 1),尿道损伤5%(n = 1),尿道吊带外露10%(n = 2),需剪断吊带。

结论

这些治愈率和并发症与标准TVT植入术一年后的情况相当,且无大腿疼痛;然而,在推荐其作为标准治疗方法之前,需要更多患者和更长时间的随访来观察长期治愈率是否能维持。

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本文引用的文献

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The MiniArc sling system in the treatment of female stress urinary incontinence.MiniArc 吊带系统治疗女性压力性尿失禁。
Int Braz J Urol. 2009 May-Jun;35(3):334-41; author reply 341-3. doi: 10.1590/s1677-55382009000300010.

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