Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
Departamento de Urologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.
Int Braz J Urol. 2018 May-Jun;44(3):543-549. doi: 10.1590/S1677-5538.IBJU.2017.0524.
Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros-pectively collected between 2012 and 2014, and divided in two groups for further comparison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de-mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.
手术矫正（SUI）是治疗压力性尿失禁（SUI）最有效的方法，经闭孔悬吊带（TO）具有最佳效果。商业上可用的吊带套件价格昂贵，这使得大多数巴西公共卫生服务机构都难以获得。另一方面，此前已经报道过手工聚丙烯吊带。本研究的目的是比较商业和手工聚丙烯网片吊带的有效性和安全性。2012 年至 2014 年期间，前瞻性收集了 57 例连续接受 TO 吊带手术治疗 SUI 的女性患者的数据，并分为两组进行进一步比较。在第 1 组中，31 名女性接受了商业吊带手术。在第 2 组中，26 名女性接受了手工聚丙烯吊带手术。根据人口统计学数据、围手术期评估、生活质量、尿动力学研究、治愈率和并发症发生率对女性进行比较。结果通过压力测试（Valsalva 动作，膀胱充盈至少 200mL）和患者总体印象改善（PGI-I）、视觉模拟量表（VAS）和国际尿失禁咨询委员会尿失禁问卷简表（ICIQ-SF）进行客观和主观评估。成功定义为 PGI-I、VAS 和压力测试阴性。第 1 组（n=31）和第 2 组（n=26）的平均年龄分别为 60 岁和 58 岁（p=0.386）。所有人口统计学数据均相似。平均 VLPP 分别为 75.6cmH2O 和 76.6cmH2O（p=0.88）。平均随访时间分别为 24.3 个月和 21.5 个月（p=0.96）。成功率分别为 74.2%和 80.2%（p=0.556），ICIQ-SF 变化分别为 12.6 和 15.5（p=0.139），PGI-I 分别为 71%和 80%（p=0.225）。只有 1 例严重并发症（第 1 组中出现尿道阴道瘘）。总之，手工和商业吊带具有相似的效果和安全性。本研究提出了制造技术的重要关键点。
