Kalra Sidhartha, Hota Sovan, Kumar Pal Atanu, Dorairajan Lalgudi N, Kodakkattil Sreenivasan Sreerag, Narkhede Vishal
Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND.
Cureus. 2023 Aug 23;15(8):e43957. doi: 10.7759/cureus.43957. eCollection 2023 Aug.
Objective The primary objective of this study was to evaluate the feasibility of performing retropubic mid-urethral transvaginal tape (TVT) with self-tailored ordinary polypropylene mesh (STOM) under sedation and local anesthesia in female patients with stress urinary incontinence (SUI). The second objective was to evaluate perioperative and immediate postoperative complications, success rates, and cost-effectivity. Materials and methods Forty-two subjects treated for stress urinary incontinence using STOM under local anesthesia were reviewed. Pre- and postoperative evaluation included assessment of valid questionnaires such as the urogenital distress inventory (UDI) and medical, epidemiologic, and social aspects of aging incontinence questionnaire (MESA), uroflowmetry in all cases, and urodynamics in some instances. Success rates and complications were compared with published studies. Results The mean operating time was 27 mins, and the median visual analog scale (VAS) score at 12 hours was three. Postoperative MESA and UDI scores had significant improvement. The mean hospital stay was 18 hours. Mean preoperative and postoperative Q max had no significant difference. With a mean follow-up of 27.32±3.29 months, the cure was seen in 38 patients (90.4%), improvement in three patients (0.07%), and failure in one patient (0.02%). Mesh-related complications (extrusion) occurred in one patient. The sling cost was reduced from approximately $500 (Gynecare TVT sling; Ethicon Inc., Somerville, NJ, USA) to $12.44 (Ethicon 15 x 7.6 cm Prolene (polypropylene mesh); Ethicon Inc., Somerville, NJ, USA) in our study. Conclusion Performing TVT with STOM under sedation and local anesthesia as a daycare procedure was feasible and cost-effective, has a high success rate, and was associated with minimal complications. It should be considered in developing countries with vast patient burdens, such as India.
目的 本研究的主要目的是评估在镇静和局部麻醉下，对压力性尿失禁（SUI）女性患者使用自制普通聚丙烯网片（STOM）行经耻骨后经阴道无张力尿道中段吊带术（TVT）的可行性。第二个目的是评估围手术期及术后即刻并发症、成功率和成本效益。材料与方法 回顾了42例在局部麻醉下使用STOM治疗压力性尿失禁的患者。术前和术后评估包括有效问卷评估，如泌尿生殖系统困扰量表（UDI）和老年失禁问卷的医学、流行病学及社会方面（MESA），所有病例均进行尿流率测定，部分病例进行尿动力学检查。将成功率和并发症与已发表的研究进行比较。结果 平均手术时间为27分钟，12小时时视觉模拟量表（VAS）评分中位数为3分。术后MESA和UDI评分有显著改善。平均住院时间为18小时。术前和术后平均最大尿流率（Q max）无显著差异。平均随访27.32±3.29个月，38例患者治愈（90.4%），3例改善（0.07%），1例失败（0.02%）。1例患者出现网片相关并发症（网片外露）。在我们的研究中，吊带成本从约500美元（Gynecare TVT吊带；美国新泽西州萨默维尔市Ethicon公司）降至12.44美元（Ethicon 15×7.6 cm普理灵（聚丙烯网片）；美国新泽西州萨默维尔市Ethicon公司）。结论 在镇静和局部麻醉下使用STOM进行TVT作为日间手术是可行且具有成本效益的，成功率高，并发症少。在像印度这样有大量患者负担的发展中国家应予以考虑。
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