Szymański Jacek K, Zaręba Kornelia, Jakiel Grzegorz, Słabuszewska-Jóźwiak Aneta
First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2020 Mar;15(1):18-29. doi: 10.5114/wiitm.2019.84702. Epub 2019 Apr 29.
The midurethral sling has become the current standard for the treatment of female stress urinary incontinence.
To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures.
The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6- and 12-month follow-up.
A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13-0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16-0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97-6.3; OR = 2.3, 95% CI: 0.95-5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality.
TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.
中段尿道吊带术已成为目前治疗女性压力性尿失禁的标准方法。
评估无张力阴道吊带术（耻骨后和经闭孔吊带术）的术中并发症、早期术后并发症以及疗效。
分析包括91例无张力阴道吊带术（TVT）和60例经闭孔吊带术（TOT）。两组在患者特征、尿动力学结果和术前生活质量（QoL）评估方面具有可比性。记录并发症情况，并在术后1、3、6和12个月随访时由患者主观评估手术效果。
TOT手术的术中及早期术后并发症风险显著较低（OR = 0.35%，95% CI：0.13 - 0.92）。此外，无论采用何种方法，有两次或更多次阴道分娩史的患者与未生育和初产妇相比，并发症风险降低（OR = 0.38%，95% CI：0.16 - 0.91）。既往妇科手术和高龄会增加并发症风险，具有临界显著性（OR分别为2.5，95% CI：0.97 - 6.3；OR为2.3，95% CI：0.95 - 5.5）。两组的治愈率、改善率和失败率相似，术后生活质量均有显著的积极变化。
TVT和TOT手术的特点是治愈率高且术后生活质量得到改善。然而，由于并发症风险降低、手术时间较短和术中失血量较少，经闭孔手术似乎应成为治疗压力性尿失禁的首选方法。
