Theodorou Ch, Floratos D, Katsifotis Ch, Moutzouris G, Mertziotis N, Thermogianni H
Department of Urology, Polycliniki Hospital, Athens, Greece.
Int Urol Nephrol. 1998;30(3):273-8. doi: 10.1007/BF02550309.
Purpose of the present study is to evaluate the efficacy of a modified Gittes procedure in the management of Type I and Type II stress urinary incontinence of the female.
Thirty-two female patients with urodynamically proven Type I and Type II stress urinary incontinence had been subjected to transvaginal incisionless bladder neck suspension (modified Gittes procedure) from September 1991 to June 1996. Their mean age was 55.2 (32-78) years. The preoperative evaluation included provocative video-urodynamics and occasional profilometry to exclude Type III stress incontinence in certain cases. The procedure described by Gittes was performed with the modification of approaching the rectus fascia through two small suprapubic incisions instead of the percutaneous original Gittes puncture.
The mean follow-up was 41 (10-66) months. Two of our patients had been lost from follow-up and were excluded from analysis. Of the remaining 30 patients, 26 (86.7%) are clinically continent. Six of them (20%) developed de novo postoperative urgency and/or urge incontinence due to bladder instability not present preoperatively. All six of them successfully managed with oral oxybutynin chloride. One diabetic patient was unable to void spontaneously and had to use the technique of clean intermittent self-catheterization (CISC) to evacuate her bladder. Of the remaining 4 (13.3%) incontinent patients, one was subjected to insertion of an artificial urinary sphincter (AUS) and one to a Burch colposuspension, both successfully. There were no major peri- or postoperative complications, with the exception of one patient with recurrent cystitis, who was treated with long-term chemoprophylaxis.
The modified Gittes bladder neck suspension is a simple and effective procedure, with no major complications and thus a good alternative to abdominal approaches.
本研究的目的是评估改良吉特斯手术治疗女性Ⅰ型和Ⅱ型压力性尿失禁的疗效。
1991年9月至1996年6月，32例经尿动力学证实为Ⅰ型和Ⅱ型压力性尿失禁的女性患者接受了经阴道无切口膀胱颈悬吊术（改良吉特斯手术）。她们的平均年龄为55.2岁（32 - 78岁）。术前评估包括激发性影像尿动力学检查，某些情况下还包括轮廓测定法，以排除Ⅲ型压力性尿失禁。吉特斯所描述的手术进行了改良，通过两个耻骨上小切口进入腹直肌筋膜，而非经皮穿刺的原始吉特斯穿刺法。
平均随访时间为41个月（10 - 66个月）。有2例患者失访，被排除在分析之外。其余30例患者中，26例（86.7%）临床控尿。其中6例（20%）术后出现新发的尿急和/或急迫性尿失禁，原因是术前不存在的膀胱不稳定。所有6例患者通过口服氯化奥昔布宁成功治疗。1例糖尿病患者无法自主排尿，不得不采用清洁间歇性自我导尿术（CISC）排空膀胱。其余4例（13.3%）尿失禁患者中，1例接受了人工尿道括约肌（AUS）植入术，1例接受了Burch阴道悬吊术，均获成功。除1例复发性膀胱炎患者接受长期化学预防治疗外，无重大围手术期或术后并发症。
改良吉特斯膀胱颈悬吊术是一种简单有效的手术，无重大并发症，因此是腹部手术方法的良好替代方案。
