Cocci Andrea, Cacciamani Giovanni E, Russo Giorgio Ivan, Cerruto Maria Angela, Milanesi Martina, Medina Luis G, Cimino Sebastiano, Artibani Walter, Morgia Giuseppe, Carini Marco, Li Marzi Vincenzo
Department of Urology, University of Florence, Florence, Italy.
Department of Urology, Polo Chirurgico "P. Confortini", Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Int Neurourol J. 2017 Dec;21(4):282-288. doi: 10.5213/inj.1734910.455. Epub 2017 Dec 31.
To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI).
We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O.
A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01).
Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.
评估术前患者特征和流速对接受经阴道无张力阴道吊带闭孔术（TVT-O）治疗单纯性压力性尿失禁（SUI）患者的手术失败、术后早期并发症及排尿情况的影响。
我们回顾性分析了3家意大利中心接受TVT-O治疗SUI的患者。排除标准包括以排尿和储尿症状为主提示逼尿肌过度活动、存在>1度的泌尿生殖器官脱垂、既往盆腔放疗或其他手术临床禁忌证、神经源性膀胱功能障碍以及胶原病。构建多因素逻辑回归模型以确定TVT-O术后早期排尿功能障碍的预测因素。
2010年1月至2015年12月期间共有219例患者接受了TVT-O治疗。所有患者在术后3、6和12个月接受随访，并进行压力试验、尿流率测定及膀胱超声检查以评估残余尿量。他们还对泌尿生殖系统困扰量表（UDI-6）问卷进行了回答。TVT-O术后持续性尿失禁、术后并发症及满意度发生率分别为16.4%（219例中的36例）、24.2%（219例中的53例）和86.3%（219例中的189例）。19例患者（9.5%）出现早期排尿功能障碍。基于对基线特征的分析，我们确定UDI-6评分为9.0时预测术后SUI的特异性为62%、敏感性为72%、准确性为66%。在多因素逻辑回归分析中，术前UDI-6≥9.0是术后SUI的独立预测因素。并发症的预测因素为绝经（P = 0.04）和术前UDI-6评分（P = 0.01）。
绝经和UDI-6评分可能是TVT-O术后持续性SUI的预后因素。需要设计良好且有足够数量患者的前瞻性研究来证实我们的发现。
