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脊髓损伤女性患者压力性尿失禁的经尿道中段吊带治疗——单中心经验

Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape - a single center experience.

作者信息

Sakalis Vasileios I, Floyd Michael S, Caygill Philippa, Price Chloe, Hartwell Ben, Guy Peter J, Davies Melissa C

机构信息

a Department of Urology, Salisbury NHS Foundation Trust , Salisbury , UK.

b Duke of Cornwall Spinal treatment center , Salisbury NHS Foundation Trust , Salisbury , UK.

出版信息

J Spinal Cord Med. 2018 Nov;41(6):703-709. doi: 10.1080/10790268.2017.1393190. Epub 2017 Oct 27.

Abstract

Context/Objective Stress urinary incontinence (SUI) affects the quality of life of females with spinal cord injury (SCI), has a negative impact on functional independence and disturbs their psychosocial interaction. Our aim was to assess the efficacy of mid-urethral tapes (MUT) in managing stress urinary incontinence in this population. Design Retrospective cohort study. Participants SCI females with upper motor neuron lesion and urodynamically proven stress or mixed urinary incontinence that was treated with a mid-urethral tape and followed up for at least 12 months. Interventions Mid-urethral tapes such TVT, TOT and mini-Arc. Patient reported outcomes based on the daily use of pads and ICIQ modular questionnaire scores. Outcome measures The primary endpoint was defined as the success rate of MUT surgery in managing stress incontinence at 12. The secondary endpoints included the improvement rate at 12 months, the complication rates and the need for additional treatments. Results 38 females were studied. At 12 months the overall patient reported success rate was 52.6%. 16% reported significant improvement. 68.4% felt the quality of life to improve. Nine patients develop tape related complications (five de novo urgency, one vaginal extrusion, one frequent dysreflexia and one worsening of incontinence). Conclusion Mid-urethral tapes are effective in the management of stress urinary incontinence in female patients with spinal cord injury. There are demonstrable improvements in both continence and quality of life.

摘要

背景/目的 压力性尿失禁(SUI)影响脊髓损伤(SCI)女性的生活质量,对功能独立性产生负面影响,并扰乱她们的心理社会互动。我们的目的是评估中段尿道吊带术(MUT)在治疗该人群压力性尿失禁方面的疗效。设计 回顾性队列研究。参与者 患有上运动神经元损伤且经尿动力学证实为压力性或混合性尿失禁的SCI女性,她们接受了中段尿道吊带术并随访至少12个月。干预措施 中段尿道吊带,如经阴道无张力尿道中段吊带术(TVT)、经闭孔无张力尿道中段吊带术(TOT)和迷你弧形吊带。基于日常护垫使用情况和国际尿失禁咨询委员会模块化问卷评分的患者报告结局。结局指标 主要终点定义为MUT手术治疗压力性尿失禁12个月时的成功率。次要终点包括12个月时的改善率、并发症发生率和额外治疗的需求。结果 对38名女性进行了研究。12个月时,总体患者报告的成功率为52.6%。16%的患者报告有显著改善。68.4%的患者感觉生活质量有所改善。9名患者出现与吊带相关的并发症(5例新发尿急、1例阴道脱垂、1例频繁反射亢进和1例尿失禁加重)。结论 中段尿道吊带术在治疗脊髓损伤女性患者的压力性尿失禁方面有效。在控尿和生活质量方面均有明显改善。

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