Chin Y K, Stanton S L
Singapore General Hospital.
Br J Obstet Gynaecol. 1995 Feb;102(2):143-7. doi: 10.1111/j.1471-0528.1995.tb09068.x.
To assess the use of silastic sling for genuine stress incontinence.
Retrospective descriptive analysis.
Tertiary referral centre for urogynaecology.
Eighty-eight women with urodynamically proven genuine stress incontinence, 10 had coexistent detrusor instability. In 74 women, the sling operation was for recurrent incontinence.
A low Pfannenstiel incision was used and a suburethral tunnel dissected to insert the sling, which was attached under minimal tension with non-absorbable sutures to each ileopectineal ligament.
Clinical and urodynamic data were assessed between two and three months post-surgery; thereafter clinical assessment and pad testing were performed at yearly intervals for five years.
The subjective cure at three months was 81% and the objective cure was 69%. There was a fall in success rate with increasing number of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05). Neither age, parity nor menopausal status made a statistical difference to the cure rate. Twenty-three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Post-operatively, 29 women had detrusor instability: 22 women developed detrusor instability de novo and seven had detrusor instability presurgery. Urodynamic findings postsurgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four bladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent.
A silastic sling operation for the treatment of genuine stress incontinence provides a good long term cure, considering that 45% of women had two or more previous failed continence operations. The high prevalence of detrusor instability and voiding difficulties postsurgery should be noted.
评估硅橡胶吊带治疗真性压力性尿失禁的效果。
回顾性描述性分析。
三级泌尿妇科转诊中心。
88例经尿动力学证实为真性压力性尿失禁的女性，其中10例并存逼尿肌不稳定。74例女性因复发性尿失禁接受吊带手术。
采用耻骨联合上横切口，分离尿道下隧道以插入吊带，用不可吸收缝线将吊带以最小张力固定于双侧髂耻束。
术后2至3个月评估临床和尿动力学数据；此后每年进行临床评估和护垫试验，持续5年。
术后3个月主观治愈率为81%，客观治愈率为69%。随着尿失禁手术次数增加，成功率下降，对于既往接受过3次或更多次尿失禁手术的女性，差异有统计学意义（P<0.05）。年龄、产次和绝经状态对治愈率均无统计学差异。23例女性完成了5年随访，采用寿命表分析的成功率为71%。术后，29例女性出现逼尿肌不稳定：22例为新发，7例术前即存在。术后尿动力学检查显示流出道阻力增加（P<0.001）。4例女性因排尿困难需取出吊带。10例女性发生吊带侵蚀：5例为阴道侵蚀，4例为膀胱侵蚀，1例为尿道侵蚀。取出吊带后，7例女性仍保持控尿。
对于45%既往有两次或更多次尿失禁手术失败的女性，硅橡胶吊带手术治疗真性压力性尿失禁可获得良好的长期疗效。应注意术后逼尿肌不稳定和排尿困难的高发生率。
