Giacalone P L, Laffargue F, Daurés J P, Lombard I, Lombard G
Service de Gynécologie-Obstétrique, Hôpital Arnaud-de-Villeneuve, Montpellier.
J Gynecol Obstet Biol Reprod (Paris). 1998 Apr;27(3):309-18.
Our purpose was to evaluate and compare the perioperative morbidity and the long-term results of the Raz colposuspension and the Bologna operation for the treatment of stress urinary incontinence in women.
Data of 188 women who underwent either a Bologna operation (group 1) or a Raz colposuspension (group 2) for the treatment of stress urinary incontinence between January 1, 1987 and December 1, 1995 were analysed retrospectively regarding history, preoperative evaluation, associated surgical procedures, complications and cure and failure rate.
80 patients were treated with the Bologna operation and 108 with the Raz colposuspension. Patients with prior anti-incontinence surgery, and patients with a preoperative diagnosis of urge incontinence were excluded from the study. Success was defined both subjectively (complete absence of complaint of stress urinary incontinence) and objectively (no evidence of loss of urine on cough provocation during physical examination). Survival curves were generated in each group for time to event data: "time to recurrent stress incontinence" and compared by the logrank test. A multivariate analysis using a Cox proportional hazards regression model was performed to indentify possible outcome predictors.
The success rate of group 1 was significantly higher than that of group 2 (p = 0.00001). The median of success was 51 months in group 1 and 21 months in group 2 (p = 0.00001). The incidence of intraoperative complications in each group (inadvertent cystostomy, hemorrhage) did not differ. The multivariate analyses using the Cox regression model showed that the most highly correlated variable with the surgical cure rate was the type of surgical anti-incontinence procedure adopted: Bologna or Raz (p = 0.00001)
In our hands, the Bologna operation has a higher cure rate than the Raz colposuspension. For us, when treating patients with stress urinary incontinence by the vaginal route, the Bologna operation is indicated when sufficient anterior vaginal tissue is available to create vaginal bands.
我们的目的是评估和比较Raz阴道悬吊术和博洛尼亚手术治疗女性压力性尿失禁的围手术期发病率及长期疗效。
回顾性分析1987年1月1日至1995年12月1日期间接受博洛尼亚手术（第1组）或Raz阴道悬吊术（第2组）治疗压力性尿失禁的188名女性的资料，内容包括病史、术前评估、相关手术操作、并发症以及治愈率和失败率。
80例患者接受博洛尼亚手术，108例接受Raz阴道悬吊术。既往有抗尿失禁手术史的患者以及术前诊断为急迫性尿失禁的患者被排除在研究之外。成功的定义包括主观上（完全没有压力性尿失禁的主诉）和客观上（体格检查时咳嗽诱发试验无尿液漏出的证据）。为事件发生时间数据（“复发性压力性尿失禁时间”）在每组中生成生存曲线，并通过对数秩检验进行比较。使用Cox比例风险回归模型进行多变量分析，以确定可能的预后预测因素。
第1组的成功率显著高于第2组（p = 0.00001）。第1组成功的中位数为51个月，第2组为21个月（p = 0.00001）。每组术中并发症（意外膀胱造瘘、出血）的发生率无差异。使用Cox回归模型进行的多变量分析表明，与手术治愈率相关性最高的变量是所采用的手术抗尿失禁方法类型：博洛尼亚手术或Raz阴道悬吊术（p = 0.00001）
在我们的研究中，博洛尼亚手术的治愈率高于Raz阴道悬吊术。对我们而言，经阴道途径治疗压力性尿失禁患者时，若有足够的阴道前壁组织可形成阴道带，则应选择博洛尼亚手术。
