Chaikin D C, Rosenthal J, Blaivas J G
Department of Urology, New York Hospital/Cornell Medical Center, New York, USA.
J Urol. 1998 Oct;160(4):1312-6.
There is a lack of consensus regarding indications and long-term efficacy of the many surgical techniques for treating stress incontinence. Historically pubovaginal sling has been reserved for cases of intrinsic sphincter deficiency or prior surgical failure. Transvaginal needle and retropubic suspensions have been used mainly for sphincteric incontinence unassociated with intrinsic sphincter deficiency. We report the long-term results of pubovaginal sling for all types of stress incontinence.
A total of 251 consecutive women with all types of stress incontinence who underwent pubovaginal fascial sling by a single surgeon were retrospectively and prospectively reviewed. Patients were evaluated preoperatively with history, physical examination, standardized symptom questionnaire, voiding diary, pad test, uroflow, post-void residual urine, video urodynamics and cystoscopy. Postoperatively women with at least 1-year followup were assessed by an independent third party (J. R.) who had no prior knowledge of them, and who recorded the parameters of the questionnaire, examination with a full bladder, voiding diary, pad test, uroflow and post-void residual urine.
Overall stress incontinence was cured or improved in 92% of the patients with at least 1-year followup (median 3.1 years, range 1 to 15). The majority of patients with postoperative incontinence had de novo (3%) or persistent (23%) urge incontinence. Permanent urinary retention developed in 4 patients (2%).
Fascial pubovaginal sling is an effective treatment for all types of stress incontinence with acceptable long-term efficacy.
对于多种治疗压力性尿失禁的外科技术，其适应症和长期疗效尚无共识。历史上，耻骨后阴道吊带术一直用于治疗内在括约肌缺陷或既往手术失败的病例。经阴道穿刺和耻骨后悬吊术主要用于与内在括约肌缺陷无关的括约肌性尿失禁。我们报告耻骨后阴道吊带术治疗所有类型压力性尿失禁的长期结果。
对由单一外科医生进行耻骨后阴道筋膜吊带术的251例连续患有所有类型压力性尿失禁的女性进行回顾性和前瞻性研究。术前通过病史、体格检查、标准化症状问卷、排尿日记、尿垫试验、尿流率、排尿后残余尿量、影像尿动力学和膀胱镜检查对患者进行评估。术后对至少随访1年的女性由一名独立的第三方（J.R.）进行评估，该第三方对她们此前一无所知，并记录问卷参数、膀胱充盈时的检查、排尿日记、尿垫试验、尿流率和排尿后残余尿量。
在至少随访1年（中位时间3.1年，范围1至15年）的患者中，总体压力性尿失禁在92%的患者中得到治愈或改善。术后尿失禁的大多数患者出现了新发（3%）或持续性（23%）急迫性尿失禁。4例患者（2%）发生了永久性尿潴留。
筋膜耻骨后阴道吊带术是治疗所有类型压力性尿失禁的有效方法，长期疗效可接受。
