Sharma J B, Deoghare Manasi Kamalakar, Bhatla Neerja, Kachhawa Garima, Mahey Reeta, Kumari Rajesh, Seth Amlesh, Sharma Alpana
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:349-354. doi: 10.1016/j.ejogrb.2020.06.062. Epub 2020 Jul 3.
To compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) STUDY DESIGN: It was a comparative study on 30 women between 25-65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases.
The baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels.
The success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.
比较自体腹直肌筋膜耻骨后阴道吊带术与合成材料经闭孔阴道吊带术治疗女性压力性尿失禁（SUI）的短期疗效。
这是一项针对30名年龄在25至65岁之间、经尿动力学证实为SUI的女性的比较研究，她们被随机分为自体腹直肌筋膜耻骨后阴道吊带术组（I组，15名女性）和合成材料经闭孔阴道吊带术组（II组，15名女性）。所有病例均进行术前和术后ICIQ（国际尿失禁咨询问卷）评分、尿动力学研究以及血清CRP和IL-6检测。
两组在年龄、体重指数（BMI）、产次、平均ICIQ评分以及术前平均CRP和IL-6水平等基线特征方面相似。I组的平均手术时间显著长于II组（55.60 ± 5.77分钟对25.27 ± 4.32分钟，p = 0.001）。I组的平均住院时间为7.1 ± 1.2天，而II组为1.2 ± 0.4天；I组的平均导尿持续时间为5.8天，而II组为1.2天（<0.01），且I组术后需要再次导尿的尿潴留发生率均显著高于II组。I组的伤口感染情况比II组更严重（p = 0.01），而II组的腹股沟疼痛明显更严重（p = 0.01）。I组有1例患者发生膀胱阴道瘘，1例患者需要剪断吊带。两组术后最大尿流率时的逼尿肌压力（Pdet at Q max）均显著升高。两组的ICIQ评分均为零，表明成功率为100%。如CRP水平显著升高所示，I组的手术创伤更大。
两组的成功率相似，但与经闭孔阴道吊带术相比，自体腹直肌筋膜吊带术耗时更长，并发症更多，尿潴留发生率更高。
