Das S
Department of Urology, Kaiser Permanente Medical Center, Walnut Creek, California 94596-5300, USA.
J Urol. 1998 Aug;160(2):368-71.
The long-term surgical outcome of abdominal colposuspension, laparoscopic colposuspension and vaginal needle suspension for managing anatomical stress urinary incontinence in women was evaluated.
Three nonrandomized contemporaneous groups of 10 women each with anatomical stress urinary incontinence were treated with abdominal colposuspension, laparoscopic colposuspension or vaginal needle suspension. Immediate postoperative and subsequent outcomes were evaluated using a 10-point questionnaire annually up to 36 months.
Immediately after surgery the laparoscopic colposuspension group required less analgesia as well as briefer catheterization and hospital stay. Continence rates 10 months postoperatively were 100% for the abdominal colposuspension group, 90% for the laparoscopic colposuspension group and 100% for the vaginal needle suspension group. At 36 months postoperatively these results had declined to 50, 40 and 20%, and satisfaction with surgical outcome was 60, 90 and 60%, respectively.
Despite initially high success rates of these 3 surgical procedures based on the principle of retropubic suspension of the proximal portion of the urethra, responses to questionnaires given at longer postoperative intervals showed a sharp decline in success. We probably should redirect our treatment strategy for women with anatomical stress incontinence to include urethral coaptation and direct suburethral suspension.
评估腹式阴道悬吊术、腹腔镜阴道悬吊术和阴道穿刺悬吊术治疗女性解剖性压力性尿失禁的长期手术效果。
将三组各10名患有解剖性压力性尿失禁的女性非随机同期分组，分别接受腹式阴道悬吊术、腹腔镜阴道悬吊术或阴道穿刺悬吊术治疗。术后立即及随后每年使用10分制问卷评估直至36个月的结果。
术后即刻，腹腔镜阴道悬吊术组所需镇痛较少，导尿时间和住院时间较短。腹式阴道悬吊术组术后10个月的控尿率为100%，腹腔镜阴道悬吊术组为90%，阴道穿刺悬吊术组为100%。术后36个月，这些结果分别降至50%、40%和20%，对手术效果的满意度分别为60%、90%和60%。
尽管基于耻骨后尿道近端悬吊原则的这三种手术最初成功率较高，但术后较长时间间隔的问卷调查结果显示成功率急剧下降。对于患有解剖性压力性尿失禁的女性，我们可能应重新调整治疗策略，纳入尿道贴合和直接尿道下悬吊。
