经耻骨后尿道中段无张力吊带术治疗女性神经源性压力性尿失禁疗效分析

Management of female neurogenic stress urinary incontinence using retropubic tension-free vaginal tape

目的评估经耻骨后尿道中段无张力吊带(retropubic tension-free vaginal tape,RP-TVT,使用合成材料)术治疗女性神经源性压力性尿失禁(NSUI)的有效性及安全性。方法回顾性分析2012年11月至2018年7月该院泌尿外科收治的有神经源性疾病史及压力性尿失禁(SUI)症状21例患者的临床资料。通过分析患者行RP-TVT术前后ICI-Q-SF、PISQ-12、最大尿流率、膀胱残余尿、生活质量评分(QOL)、症状评分[漏尿次数评分+漏尿量评分]等,评估RP-TVT术治疗女性NSUI的疗效。随访11~66个月,平均(37.05±14.28)个月。结果21例女性患者年龄43~72岁,平均59.71岁。随访3、12、24、36个月完全控尿患者分别85.7%(18/21)、85.0%(17/20)、88.9%(16/18)、86.7%(13/15)。症状评分由(8.67±2.11)分降至(0.67±1.91)分,QOL由(8.43±1.33)分降至(0.87±1.81)分,PISQ-12评分由(21.00±2.41)分增至(24.80±2.60)分。术后不同随访时间点症状评分、QOL、PISQ-12评分与术前比较,差异均有统计学意义( P <0.05)。8例术前合并逼尿肌无力/活动度低的患者术后并发尿潴留。结论RP-TVT治疗女性NSUI效果确切,且安全、微创,值得临床推广使用。

Objective Many types of procedure have been utilized to treat female neurogenic stress urinary incontinence(NSUI).Nevertheless,which treatment is most effective still remains controversial.The aim of our study is to evaluate the effectiveness of a less invasive treatment for femal NSUI with retropubic tension-free vaginal tape(RP-TVT,using synthetic material). Methods We retrospectively included patients with neugenic diseases in this study,complaining of stress urinary incontinence(SUI) and treated an our institution with RP-TVT.Diagnosis of NSUI was achieved with clinical history data collection and urodynamic testing. Results We treated 21 women by RP-TVT,mean age 59.71 years(range 43-73).Follow-ups was 37.05 months(range 11-66).The complete continence cases at 3,12,24,36 months follow-ups were 18(85.7%),17(81.0%),16(76.2%),13(61.9%),respectively.The FOL-VOL scores decreased from(8.67±2.11) to (0.67±1.91),QOL scores decreased from (8.43±1.33) to (0.87±1.81),and PISQ-12 scores increased from(21.00±2.41) to (24.80±2.60). The main complication was urinary retention,which occurred in 8 patients with detrusor areflex/underactive. Conclusion RP-TVT in patients with NSUI is minimally invasive and safe.It can significantly improve NSUI in the long term.Thus,it might be a reasonable option for patients who are not willing,not suitable or not yet ready for more invasive surgery,such as artificial urinary sphincter or fascial suspension sling placement.