无张力尿道悬吊术治疗压力性尿失禁

Tension free mid urethral slings in treatment of stress urinary incontinence

目的:总结经无张力尿道悬吊术治疗压力性尿失禁的临床疗效。方法:回顾性分析我院5年来压力性尿失禁患者接受无张力吊带手术患者46例(年龄35～72岁,平均53岁),其中女43例,男3例。采用经阴道无张力尿道吊带术(TVT)13例,经阴道-闭孔中段尿道吊带术(TVT-O)25例,经会阴-闭孔男性尿道球部悬吊术3例,耻骨上(Sparc)中段尿道吊带术5例。其中9例局麻下完成,其余在腰麻下完成。结果:5例患者失访,40例随访10～50个月尿失禁治愈32例,改善8例。7例术后出现短暂尿潴留,1例出现顽固性排尿困难,膀胱穿孔1例,余手术前后最大尿流率及残尿量差异无显著性;无尿道腐蚀、吊带感染、术后持续疼痛等并发症发生。结论:无张力尿道中段吊带悬吊术是治疗压力性尿失禁可靠方法,疗效确切,操作简单,男性压力性尿失禁(SUI)近期疗效较佳,但长期疗效尚待进一步观察。

Objeetive ：To review and analyze the eurative effects of tension-free urethral tape suspension operation on the treatment of stress urinary ineontinenee（SUI）.Methods：We conducted a cohort study of 46 patients （age 35 to 72 years, median 53 ） suffered stress urinary incontinence treated with a ＂mid-urethral tension-free＂ tape procedure in our hospital during the past 5 years.Among them, mate 3 and female 43 ,thirteen eases underwent retropubie-mid urethral slings （tension free vaginal tap TVT） suspension procedures,25 transobturator mid urethral slings （trans-obturator suburethral tape from inside to outside TVT-O） and 3 underwent the inside-out transobturator sling （IOS,perineo-bulbus urethrae-obturatorium tension free tap suspension）,5 accepted suprapubic arch sling （Sparc） procedures.And anterior colporrhaphy in 11.Nine cases of TVT of TVT-O approach were performed under local anaesthesia and others were performed under lumbar anesthesia.Results：Forty cases were followed up for 10-50 months （five patients failied to follow-up）,32 patients were cured（80%） and 8 others（20%） were improved（1 pad/day）.Short-term complications included 7 patients emerged temporary urinary retention and 1 developed dysuria,and one case of bladder perforation.Preoperative and postoperative max flow rate and postvoid residual values were not statistically different.No urethra erosion,sling ilffection,persistent pain complication was observed.Conclusion： Tension-free mid urethral slings operation is a curative and secured method for stress urinary incontinence.According to our data,the overall short-term results of tension free slings in man affected by SUI are satisfatory.But long-term outcome and data remained unclear.