Raz S, Stothers L, Young G P, Short J, Marks B, Chopra A, Wahle G R
Division of Urology, University of California Los Angeles, USA.
J Urol. 1996 Jul;156(1):166-70.
A prospective cohort study was done to determine the efficacy and clinical outcome of a new technique for anterior vaginal wall sling construction to treat urinary incontinence due to intrinsic sphincter dysfunction or anatomical incontinence.
Preoperative evaluation included lateral cystography, video urodynamics, cystoscopy and incontinence staging. Postoperative subjective and objective staging outcome measures were prospectively assigned at predetermined regular intervals by a third party.
Of the patients 95 had intrinsic sphincter dysfunction and 65 had anatomical incontinence. The repair failed in 7% of the 160 patients who had recurrent incontinence during followup and 9% had de novo urgency incontinence. Time to failure comparing patients with intrinsic sphincter dysfunction and anatomical incontinence was modeled using Kaplan-Meier survival curves, and the log rank test showed no significant difference between the groups (p > 0.05). Logistic regression covariates revealed no significant predictive factors for postoperative failures. Preoperative patient age was the only predictive factor for de novo instability (logistic regression model p < 0.05).
Our initial results indicate that the 2 groups are indistinguishable to date based on current clinical and experimental statistics except for time to full recovery of postoperative voiding and incidence of postoperative instability (regression model p < 0.05).
进行一项前瞻性队列研究，以确定一种新的阴道前壁吊带构建技术治疗因固有括约肌功能障碍或解剖性尿失禁所致尿失禁的疗效及临床结局。
术前评估包括侧位膀胱造影、影像尿动力学、膀胱镜检查及尿失禁分期。术后主观和客观分期结局指标由第三方在预定的固定时间间隔进行前瞻性评估。
患者中，95例有固有括约肌功能障碍，65例有解剖性尿失禁。160例患者中，7%在随访期间出现复发性尿失禁，修复失败，9%出现新发急迫性尿失禁。采用Kaplan-Meier生存曲线对固有括约肌功能障碍患者和解剖性尿失禁患者的失败时间进行建模，对数秩检验显示两组间无显著差异（p>0.05）。逻辑回归协变量未显示术后失败的显著预测因素。术前患者年龄是新发不稳定的唯一预测因素（逻辑回归模型p<0.05）。
我们的初步结果表明，根据目前的临床和实验统计数据，除术后排尿完全恢复时间和术后不稳定发生率外，两组至今尚无差异（回归模型p<0.05）。
