Elkabir J J, Mee A D
Department of Urology, Northwick Park and St. Mark's Hospital, London, United Kingdom.
J Urol. 1998 Apr;159(4):1203-5.
We evaluate the long-term outcome of the Gittes procedure for urinary stress incontinence.
A total of 87 women with proved genuine stress incontinence were treated with the Gittes procedure. The same urologist performed 95 consecutive operations during an 8-year period. Patients were evaluated by a postal questionnaire.
Of the patients 52 (60%) (55 operations) responded to the questionnaire. Mean and median followup were 53 and 46 months, respectively (range 24 to 103). Twelve patients (23.1%) reported complete absence of postoperative urinary incontinence and were considered cured, 14 (26.9%) were significantly improved and a total of 30 (57.7%) benefited from the operation. The short-term results were initially encouraging but by 2 years only 20 patients were completely continent (38.5% cured). Of the 40 patients who were not cured 32 (80.0%) experienced incontinence within 2 years postoperatively. There were 26 who had complained of frequency and/or urgency preoperatively. There was a statistically significant subjective failure rate in this group (p = 0.007).
The Gittes procedure is simple and has minimal complications. Although it provides continence in the early weeks and months following surgery, the long-term cure rate is disappointing, with most failures occurring within 2 years of surgery. Preoperative irritative symptoms, even when multichannel cystometry did not reveal instability, were associated with a poor subjective outcome. Our results suggest that the Gittes procedure is not satisfactory for the management of genuine stress incontinence in women.
我们评估吉特斯手术治疗压力性尿失禁的长期疗效。
共有87例确诊为真性压力性尿失禁的女性接受了吉特斯手术。同一位泌尿科医生在8年期间连续进行了95例手术。通过邮寄问卷对患者进行评估。
52例患者（60%）（55例手术）回复了问卷。平均随访时间和中位随访时间分别为53个月和46个月（范围24至103个月）。12例患者（23.1%）报告术后完全无尿失禁，被视为治愈；14例（26.9%）有显著改善，共有30例（57.7%）从手术中获益。短期结果最初令人鼓舞，但到2年时只有20例患者完全控尿（治愈率38.5%）。在40例未治愈的患者中，32例（80.0%）在术后2年内出现尿失禁。术前有26例患者抱怨尿频和/或尿急。该组主观失败率有统计学意义（p = 0.007）。
吉特斯手术操作简单，并发症极少。尽管它在术后早期几周和几个月能实现控尿，但长期治愈率令人失望，大多数失败发生在术后2年内。术前的刺激性症状，即使多通道膀胱测压未显示不稳定，也与主观预后不良相关。我们的结果表明，吉特斯手术对女性真性压力性尿失禁的治疗并不令人满意。
