Jiang Zhuo, Yuan Chaoyan
Department of Medical School, Hubei Minzu University, Enshi, Enshi Tujia and Miao Autonomous Prefecture, Hubei, People's Republic of China.
Department of Gynecology, Minda Hospital of Hubei Minzu University, Enshi, Enshi Tujia and Miao Autonomous Prefecture, Hubei, People's Republic of China.
Int J Womens Health. 2024 Nov 29;16:2051-2063. doi: 10.2147/IJWH.S488235. eCollection 2024.
To compare the efficacy of autologous fascial retropubic midurethral sling, anterior vaginal wall epithelial flap midurethral suspension, tension-free vaginal tape-obturator and adjustable urethral suspension with a single incision for the treatment of female stress urinary incontinence.
A total of 243 SUI patients who were admitted to Minda Hospital of Hubei Minzu University, were chosen and split into four groups based on various surgical techniques: the AFS group (59 cases), TVT-O group (61 cases), epithelial flap group (62 cases) and ASIS group (61 cases). A comparison of four patient groups' quality-of-life scores, urodynamic indices, urethral structure-related indices before and a year after treatment, complication rates and perioperative-related indices.
There was no discernible difference in the treatment outcomes among the four groups(P>0.05). However, the ASIS group exhibited significantly reduced intraoperative hemorrhage, hospitalization duration and operative time compared to the mucosal flap and TVT-O groups(P<0.05). Both the TVT-O and ASIS groups demonstrated significantly higher hospitalization expenditures than the mucosal flap and AFS groups (P<0.05). No significant differences were observed in postoperative indwelling catheterization, IIQ-7 and I-QOL ratings, urodynamic indices or urethral structure-related indexes across the four patient groups(P>0.05). The TVT-O group showed a significantly higher incidence of postoperative medial thigh pain compared to the AFS, mucosal flap, and ASIS groups(P<0.05). Similarly, the AFS group had a significantly greater incidence of postoperative urine retention compared to the mucosal flap, TVT-O, and ASIS groups(P<0.05).
While all four surgical techniques demonstrated good efficacy and improved patients' quality of life, our study suggests that TVT-O had a significantly higher incidence of post-treatment medial thigh pain and ASIS may be a safer and less problematic surgical approach for the treatment of female SUI. This has important therapeutic implications.
比较自体筋膜耻骨后尿道中段悬吊术、阴道前壁上皮瓣尿道中段悬吊术、经闭孔无张力尿道中段吊带术及单切口可调节尿道悬吊术治疗女性压力性尿失禁的疗效。
选取湖北民族大学附属民大医院收治的243例压力性尿失禁患者，根据不同手术方式分为四组：自体筋膜耻骨后尿道中段悬吊术（AFS）组59例、经闭孔无张力尿道中段吊带术（TVT-O）组61例、上皮瓣组62例、单切口可调节尿道悬吊术（ASIS）组61例。比较四组患者治疗前及治疗1年后的生活质量评分、尿动力学指标、尿道结构相关指标、并发症发生率及围手术期相关指标。
四组治疗效果差异无统计学意义（P>0.05）。然而，与黏膜瓣组和TVT-O组相比，ASIS组术中出血量、住院时间及手术时间明显减少（P<0.05）。TVT-O组和ASIS组的住院费用均明显高于黏膜瓣组和AFS组（P<0.05）。四组患者术后留置导尿时间、IIQ-7和I-QOL评分、尿动力学指标及尿道结构相关指标差异无统计学意义（P>0.05）。与AFS组、黏膜瓣组和ASIS组相比，TVT-O组术后大腿内侧疼痛发生率明显更高（P<0.05）。同样，与黏膜瓣组、TVT-O组和ASIS组相比，AFS组术后尿潴留发生率明显更高（P<0.05）。
虽然四种手术方式均显示出良好的疗效并改善了患者的生活质量，但本研究表明，TVT-O术后大腿内侧疼痛发生率明显更高，而ASIS可能是治疗女性压力性尿失禁更安全、问题更少的手术方式。这具有重要的治疗意义。
