Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Int Urogynecol J. 2020 Aug;31(8):1633-1640. doi: 10.1007/s00192-019-04068-8. Epub 2019 Aug 2.
Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI.
This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT "in-out" fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12 months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables.
There were 81 patients in group I and 83 in group II. Median follow-up duration was 12 months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024).
Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.
压力性尿失禁（SUI）和膀胱膨出常同时发生，因此可能可以通过单一手术来治疗。本研究评估了经闭孔吊带（TOT）与经阴道前壁修补术同时治疗膀胱膨出相关 SUI 的疗效和安全性。
这是一项前瞻性临床试验，纳入了患有膀胱膨出相关 SUI 的女性患者。患者被随机分配到 I 组（经阴道前壁修补术联合 TOT“内-外”固定）或 II 组（植入经阴道四臂网片）。所有患者在术后 1、3、6、9 和 12 个月进行随访。采用统计学检验比较两组的手术结果，包括客观、主观和解剖学变量。
I 组 81 例，II 组 83 例。中位随访时间为 12 个月。两组的人口统计学数据和基线临床特征相似。两组在 SUI 和膀胱膨出修复的成功率方面无显著差异。I 组和 II 组的 SUI 治愈率（分别为 82.9%和 88.4%；p=0.369）和膀胱膨出修复成功率（分别为 85.4%和 97.7%；p=0.055）相似。两组均未发生尿道或膀胱损伤或网片侵蚀。两组的术后并发症相似，仅 I 组在早期随访时（12.2%对 0.0%；p=0.024）排尿困难的发生率高于 II 组。
经阴道网片并不优于固有组织修复。经阴道前壁修补术联合 TOT 可能是经阴道四臂网片应用的一种合适替代方法，用于同时治疗 SUI 和膀胱膨出。
