Frey Janine N, Zellweger Mélanie, Krebs Jörg, Christmann Corina
Luzerner Kantonsspital Frauenklinik, 6000 Luzern, Switzerland.
Clinical Trial Unit, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland.
J Clin Med. 2023 Aug 21;12(16):5422. doi: 10.3390/jcm12165422.
Urinary stress incontinence is a distressing condition that has a severe impact on quality of life for most affected women. The insertion of the suburethral tension-free vaginal tape (TVT) is regarded as the gold-standard surgical treatment option. It is unclear whether all women with severe SUI benefit equally from TVT. Thus, the aim of our study was to identify risk factors for severe SUI and determine whether successful the resolution of incontinence after a TVT procedure was different in women with a higher degree of SUI. In total, 168 women were included in this retrospective cohort study. Women with severe SUI showed a significantly lower maximum urethral closure pressure (MUCP) (median 53 cmHO in moderate vs. 39 cmHO in severe, = 0.001) and higher BMI (median 26.1 kg/m in moderate vs. 28.5 kg/m in severe, = 0.045). Sonographic bladder neck funneling was detected significantly more often in women with severe SUI (27% in moderate vs. 57% in severe, = 0.004). Lower MUCP and higher BMI were identified as significant predictors of severe SUI ( < 0.032). There was no difference in parity, age, functional urethral length and negative urethral stress pressure. Overall postoperative continence after the insertion of TVT was 91.9%. We found no significant difference in postoperative continence between women with severe vs. moderate SUI, suggesting that in our cohort the success of TVT was not significantly affected by the severity of SUI. In our cohort, low MUCP and high BMI were shown to be significant predictors of SUI severity. Nevertheless, treatment success of SUI with TVT did not differ substantially in women with more severe SUI.
压力性尿失禁是一种令人苦恼的疾病，对大多数受影响的女性的生活质量有严重影响。经阴道无张力尿道中段吊带术（TVT）被视为金标准的手术治疗选择。目前尚不清楚所有重度压力性尿失禁女性是否都能从TVT中同样受益。因此，我们研究的目的是确定重度压力性尿失禁的危险因素，并确定TVT手术后尿失禁的成功解决在不同程度压力性尿失禁女性中是否存在差异。本回顾性队列研究共纳入168名女性。重度压力性尿失禁女性的最大尿道闭合压（MUCP）显著更低（中度为中位数53cmH₂O，重度为39cmH₂O，P = 0.001），且体重指数更高（中度为中位数26.1kg/m²，重度为28.5kg/m²，P = 0.045）。重度压力性尿失禁女性中超声检查发现膀胱颈漏斗形成的比例显著更高（中度为27%，重度为57%，P = 0.004）。较低的MUCP和较高的体重指数被确定为重度压力性尿失禁的显著预测因素（P < 0.032）。在产次、年龄、功能性尿道长度和尿道负压力方面没有差异。TVT置入术后总体控尿率为91.9%。我们发现重度与中度压力性尿失禁女性术后控尿情况无显著差异，这表明在我们的队列中，TVT的成功率并未受到压力性尿失禁严重程度的显著影响。在我们的队列中，低MUCP和高体重指数被证明是压力性尿失禁严重程度的显著预测因素。然而，TVT治疗压力性尿失禁的成功率在更重度压力性尿失禁女性中并没有实质性差异。
