Rodrigues Claudinei A, Bianchi-Ferraro Ana Maria H M, Zucchi Eliana Viana Monteiro, Sartori Marair G F, Girão Manoel J B C, Jarmy-Di Bella Zsuzsanna I K
Sector of Urogynecology and Vaginal Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
Rev Bras Ginecol Obstet. 2017 Sep;39(9):471-479. doi: 10.1055/s-0037-1606125. Epub 2017 Aug 28.
Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student -test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; = 0.630). The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
我们旨在通过三维超声（3D-US）比较手术三年后，不同尿道中段吊带置入技术治疗压力性尿失禁时吊带的位置以及吊带臂形成的角度。此外，我们还研究了超声检查结果与术后晚期临床结果之间的相关性。对2009年5月至2011年12月间接受吊带手术的170例患者进行了一项前瞻性横断面队列研究。最终样本包含质量足够的超声图像，其中有26例耻骨后吊带（无张力阴道吊带，TVT）、42例经闭孔吊带（无张力阴道吊带-闭孔，TVT-O）和37例单切口吊带（无张力阴道吊带-Secur，TVT-S）。由2名对手术和尿失禁状况不知情的观察者离线分析图像（静息状态、Valsalva动作期间和盆底收缩期间）。采用Student检验、卡方检验和Kruskal-Wallis检验进行组间比较，并采用Tukey多重比较进行方差分析。
结果发现，各组之间在吊带臂的平均角度（TVT = 119.94°，TVT-O = 141.93°，TVT-S = 121.06°；<0.001）以及静息时膀胱颈与吊带之间的距离（TVT = 1.65 cm，TVT-O = 1.93 cm，TVT-S = 1.95 cm；= 0.010）方面存在差异。总体客观治愈率为87.8%（TVT = 88.5%，TVT-O = 90.5%，TVT-S = 83.8%；= 0.701）。总体主观治愈率为83.8%（TVT = 88.5%，TVT-O = 88.5%，TVT-S = 78.4%；= 0.514）。85.7%的患者吊带位于尿道中段（TVT = 100%，TVT-O = 73.8%，TVT-S = 89.2%；= 0.001），位置更靠下与肥胖相关（靠下：66.7%为肥胖患者；尿道中段：34%为肥胖患者；= 0.003）。23.8%的患者出现尿急相关症状（TVT = 30.8%，TVT-O = 21.4%，TVT-S = 21.6%；= 0.630）。
与耻骨后或单切口吊带相比，经闭孔吊带的吊带臂形成的角度更钝。与其他吊带相比，耻骨后吊带更常位于尿道中段，无论患者是否肥胖。然而，术后三年分析的超声测量结果与尿路症状无相关性。
