Sharma J B, Thariani Karishma, Kumari Rajesh, Kaur Tanudeep, Uppal Bharti, Pandey Kavita, Dalal Venus
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Room No. 3064A, III Rd Floor, Teaching block, New Delhi, 110029 India.
J Obstet Gynaecol India. 2021 Jun;71(3):285-291. doi: 10.1007/s13224-020-01398-2. Epub 2021 Jan 22.
Stress urinary incontinence (SUI) is involuntary leakage of urine on raised intra- abdominal pressure which adversely affects quality of life usually requiring surgical treatment.
This is a prospective study of efficacy, cure rates and complications of tension free transobturator tape (TOT) surgery on 85 women with SUI. Pre-operatively and 6 months post-operatively International consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) scores were calculated for all patients to know the severity of incontinence and efficacy of tape.
Mean age, parity, body mass index and mean duration of symptoms were 45.78 years, 2.68, 26.38 kg/m2 and 3.85 years, respectively. SUI was demonstrated in all cases on cough stress test and Bonney's test. Mean operative time, blood loss, post-operative analgesic injections, post- operative stay and post- operative catheterisation were 23.28 min, 45.50 ml, 1.2 injections, 1.2 days and 1.2 days. Various complications noted were excessive bleeding (3.52%), urinary retention (7.05%), urinary urgency (8.23%), urinary tract infection (2.35%), surgical site infection (1.17%), groin pain (28.23%) and mesh exposure (3.52%). At 6 months follow-up, the complete cure rate was 83.52% , partial cure rate was 11.76% and failure rate was found to be 4.70% whereas it was 79.16%, 12.0% and 8.33% respectively at 3 years follow up. 2 patients (2.35%) required burch colposuspension and 12 patients (14.11%) required pelvic floor exercises and duloxetine therapy for their symptoms. Mean pre- operative ICIQ-SF score reduced post- operatively (17.8 ± 4.67 to 2.71 ± 1.42) ( value = 0.001).
Study demonstrates short and long-term efficacy and safety of TOT for surgical management of SUI.
压力性尿失禁（SUI）是指腹内压升高时尿液不自主漏出，这会对生活质量产生不利影响，通常需要手术治疗。
这是一项针对85例压力性尿失禁女性患者进行的无张力经闭孔尿道中段吊带术（TOT）手术疗效、治愈率及并发症的前瞻性研究。术前及术后6个月，计算所有患者的国际尿失禁咨询委员会简表（ICIQ-SF）评分，以了解尿失禁的严重程度及吊带的疗效。
平均年龄、产次、体重指数及平均症状持续时间分别为45.78岁、2.68、26.38kg/m²及3.85年。所有病例在咳嗽压力试验和邦尼试验中均表现为压力性尿失禁。平均手术时间、失血量、术后镇痛注射次数、术后住院时间及术后导尿时间分别为23.28分钟、45.50毫升、1.2次注射、1.2天及1.2天。观察到的各种并发症包括出血过多（3.52%）、尿潴留（7.05%）、尿急（8.23%）、尿路感染（2.35%）、手术部位感染（1.17%）、腹股沟疼痛（28.23%）及网片外露（3.52%）。在6个月随访时，完全治愈率为83.52%，部分治愈率为11.76%，失败率为4.70%；而在3年随访时，分别为79.16%、12.0%及8.33%。2例患者（2.35%）因症状需要进行伯奇阴道悬吊术，12例患者（14.11%）需要进行盆底肌锻炼及度洛西汀治疗。术前ICIQ-SF平均评分术后降低（从17.8±4.67降至2.71±1.42）（P值=0.001）。
研究表明TOT手术治疗压力性尿失禁具有短期和长期疗效及安全性。
