Zhang W Y, Zhang X P, Hu H, Chen J W, Liu X H, Xu K X
Department of Urology, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Aug 18;49(4):638-642.
To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI).
Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up. Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT). Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared.
The mean age was 62 years, with a range of 42-80 years. The mean body mass index (BMI) was 26.82 kg/m, with a range of 21.48-31.14 kg/m. The mean follow-up time was 26 months, with a range of 8-69 months. Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks. None of the patients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery. After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination. The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured. The patients' life quality also improved significantly (P<0.05).
Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were. And 16 patients didn't show an overactive bladder, which may due to two reasons. One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra. Proximal urethra is full of nerve, which plays a role in sense and urine control. The sense of urge may come from urethra instead of bladder. tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence. Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%. The efficacy of surgery remained stable in medium and long term, and the patients' quality of life improved significantly.
评估无张力尿道中段吊带术治疗女性混合性尿失禁（MUI）的中长期疗效。
对2010年4月至2016年9月期间接受无张力尿道中段吊带术治疗MUI的26例患者进行随访。26例患者中，4例行耻骨后无张力尿道中段吊带术（TVT），22例行经尿道闭孔中段吊带术（TOT）。随访时使用尿失禁严重程度评分（UISS）、逼尿肌不稳定评分（DIS）、尿失禁生活质量量表评估（I-QOL）、泌尿生殖系统困扰问卷简表（UDI-6）等量表，比较手术前后的结果。
患者平均年龄62岁，范围为42-80岁。平均体重指数（BMI）为26.82kg/m，范围为21.48-31.14kg/m。平均随访时间26个月，范围为8-69个月。12例患者从未服用M受体阻滞剂，其余14例患者在两周内服用过M受体阻滞剂。所有患者术中均未出现并发症，包括排尿困难、膀胱、尿道、闭孔血管或神经损伤。拔除导尿管后，无患者出现中度或重度疼痛或排尿困难。压力性尿失禁（SUI）的总体治愈率为96.15%，25例患者治愈；急迫性尿失禁（UUI）的治愈率为76.92%，20例患者治愈。患者生活质量也有显著改善（P<0.05）。
26例患者中，10例经尿动力学检查显示膀胱过度活动症，其中6例治疗失败患者均在此列。另外16例患者未显示膀胱过度活动症，可能有两个原因。一是他们的尿急感不严重，另一个是他们的尿急感来自尿道。尿道近端神经丰富，在感觉和控尿方面起作用。尿急感可能来自尿道而非膀胱。无张力尿道中段吊带术是治疗女性混合性尿失禁的有效方法。即使未服用M受体阻滞剂，急迫性尿失禁的治愈率也达到76.92%。手术疗效在中长期保持稳定，患者生活质量显著改善。
