Wlaźlak Edyta, Viereck Volker, Kociszewski Jacek, Kuszka Andrzej, Rautenberg Oliver, Walser Claudia, Surkont Grzegorz, Gamper Marianne, Fehr Mathias K
Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland.
Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
Neurourol Urodyn. 2017 Sep;36(7):1910-1916. doi: 10.1002/nau.23211. Epub 2017 Jan 31.
Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes.
One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria.
Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm.
The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.
固有括约肌缺陷（ISD）是无张力阴道吊带术（TVT）置入术后治疗失败的已知风险因素。本研究的目的是调查单独的ISD严重程度或其他因素（如尿道活动度和吊带位置）是否会影响治疗结果。
纳入109例经尿动力学确定为ISD、接受TVT置入术并进行了6个月随访的女性。通过盆底超声评估尿道长度、活动度和吊带位置。患者被分为三个尿道活动度组（活动度降低、正常活动度、活动度增加）。通过客观和主观标准相结合的方式评估手术结果。
TVT置入术后的治疗成功率为81.6%。ISD的严重程度与治疗失败无关。但治愈组和未治愈组之间的尿道活动度（P < 0.0001）、吊带相对位置（P = 0.0003）和吊带-尿道距离（P < 0.0001）存在差异。吊带相对位置位于尿道长度1/2处的患者治愈率更高。活动度降低（67%）、正常活动度（76%）和活动度增加（100%）的尿道治愈率差异有统计学意义（P = 0.0003）。对于尿道活动度降低的ISD患者，吊带-尿道距离在2.5至3.5 mm之间时治愈率最高。
ISD患者治愈率降低是由于尿道活动度降低的亚组所致。需要进行前瞻性研究以证实，对于该患者群体，稍短的吊带-尿道距离和更靠近尿道中部的吊带相对位置将带来更好的治疗效果。
