Search

Clinical Comparison between Tension-Free Vaginal Tape and Tension-Free Vaginal Tape-obturator for Female Stress Urinary Incontinence

ObjectiveTo compare the clinical outcome of tension-free vaginal tape (TVT) and TVT-obturator (TVT-O) for female stress urinary incontinence (SUI). MethodsSixty-one female SUI patients were included in our study, in which 33 received TVT procedure and 28 received TVT-O procedure. The patients were followed up for 1 to 62 months post-operatively, averaging at 22 months. Cure was defined as no leakage during the stress test and no residual urine showed by B ultrasound, improvement as less leakage during the stress test after operation, and inefficacy as leakage during the stress test and no difference was detected after operation. ResultsAge and disease course were not significantly different between the two groups (P>0.05). All patients underwent TVT or TVT-O procedure successfully. Time of TVT ranged from 26 to 45 min averaging at (35.5±4.3) minutes, and it was significantly different from the time of TVT-O which ranged from 15 to 20 min averaging at (7.2±3.1) minutes (P<0.05). Bleeding during the surgery was not significantly different between the two groups (P>0.05). The rate of complications occurring during TVT-O procedure was significantly less and milder than that during the TVT procedure (P<0.05). The cure rate and improvement rate indicated no significant differences between the two groups (P>0.05). ConclusionThe evidence available indicates that TVT and TVT-O procedure are both effective and safe for female SUI. Compared with TVT, TVT-O procedure has the advantages of being more convenient, shorter operation time, being less invasive, and fewer complications, and it may be more suitable for female SUI.

經恥骨上膀胱尿道懸吊術治療女性壓力性尿失禁圍手術期的護理

摘要:目的: 探討經恥骨上膀胱尿道懸吊術（SPARC）圍手術期的護理。方法: 我科室于2007年1月至2008年6月采用SPARC治療6例臨床診斷為女性壓力性尿失禁的病人，進行圍手術期護理。結果: 住院3～7天，平均5天。6例病人術后尿控滿意，隨訪3月，1例有輕度尿失禁，余無排尿困難、尿失禁及尿路感染。結論: SPARC治療女性壓力性尿失禁具有簡單、安全、創傷小、療效好的特點，再配合積極的護理，有效的膀胱功能鍛煉，是提高術后效果，促進排尿自控的重要措施，值得臨床推廣。

Quality appraisal of evidence-based guidelines for the management of female stress urinary incontinence

ObjectivesTo evaluate the quality of evidence-based guidelines for the treatment of female stress urinary incontinence, so as to provide evidence for clinical stress urinary incontinence management research.MethodsWebsite of the professional society, clinical practice guide website, Yimaitong website, PubMed, CNKI, WanFang Data and VIP databases were electronically searched to collect stress urinary incontinence management related guidelines from January 1st, 2014 to January 1st, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included guidelines using Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the characteristics of each guidelines were analyzed.ResultsWe identified totally 8 relevant evidence-based guidelines in this field. The average standardized scores in the 6 domains of AGREE II were 90.74% (scope and purpose), 78.71% (stakeholder involvement), 74.60% (rigor of development), 93.52% (clarity of presentations), 61.81% (applicability), and 91.67% (independence). The overall standardized scores of 8 guidelines were 77.70%, and the total scores were 5.31 (out of 7). For overall quality, 4 of them were grade A and 4 of them were grade B.ConclusionsThe overall quality of evidence-based guidelines for stress urinary incontinence is high, and scores in different fields are vary large. Fields of " stakeholder involvement”, " rigor of development” and " applicability” with lower scores still requires strengthening. The current guidelines for female stress urinary incontinence in China still fails to meet the standards of evidence-based guidelines, so the quality of the guidelines should be improved to improve guide clinical practice.

TREATMENT OF FEMALE STRESS URINARY INCONTINENCE WITH TENSION-FREE VAGINAL TAPE

Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.

托吡酯治療導致成人癲癇患者尿失禁二例

The Investigation of the Appliances for Urinary Incontinence in Elderly Male Patients

目的:了解成都市住院老年男性尿失禁患者尿失禁處理用物的使用及并發癥發生情況。方法:用自行設計的量表對188位尿失禁老人的一般情況、尿失禁的分級及處理用物等進行調查。結果:隨著尿失禁的嚴重程度的增加,患者或其家人選擇的處理用物增加。男性尿失禁的不同處理用物被選用的多少依次為:尿布(585%)、尿壺(340%)、一次性尿墊(255%)、保鮮袋(186%)、避孕套式尿袋(69%)、留置導尿(37%)及假性尿器(27%),不同尿失禁分級的患者對處理用物的選擇差異有統計學意義(Plt;005);2周患者399%發生漏尿,133%局部皮膚發紅,27%皮膚糜爛及21%尿路感染。結論:臨床工作中應該根據尿失禁的不同分級及患者的綜合情況指導患者及其照顧者選擇合適的處理用物,目前老年男性尿失禁患者仍然欠缺舒適、經濟、實用的接尿設備。

恥骨后無張力陰道吊帶術治療女性壓力性尿失禁

目的 探討恥骨后無張力陰道吊帶術（tension-free vaginal tape technique，TVT）治療女性壓力性尿失禁（stress urinary incontinence，SUI）的臨床療效。 方法 回顧分析2004 年1 月－ 2010 年1 月57 例采用TVT 治療的女性SUI 患者臨床資料。患者年齡36 ～ 64 歲，平均54 歲；病程1 年6 個月～ 13 年。均有1 ～ 3 次生育史。誘發試驗及膀胱頸抬舉試驗均呈陽性。14 例合并陰道前壁脫垂。5 例有逼尿肌不穩定表現。漏尿點壓測定為3.93 ～ 10.98 kPa。 結果 4 例術中發生穿破膀胱，重新調整方向后完成手術。3 例拔除尿管后出現排尿困難，經對癥處理后恢復正常排尿。術后12 個月采用Grouts-Blaivas 評分法評價療效，治愈48 例（84.2%），改善良好8 例（14.0%），改善中等1 例（1.8%）。尿流動力學檢查示，術后3、12 個月尿流率較術前顯著下降，最大尿道閉合壓顯著升高（P lt; 0.05）。根據尿失禁生活質量量表（I-QOL）評價，術后3 個月患者在日常活動、心理障礙及社會尷尬方面的主要評分指標較術前有顯著性提高（P lt; 0.05）；術后12 個月患者各項指標均較術前改善（P lt; 0.05）。 結論 TVT 手術操作簡便、安全有效，能顯著提高患者生活質量，是治療女性SUI 的有效手段。

EXPERIMENTAL STUDY ON COMBINING SELECTIVE RHIZOTOMY OF DIFFERENT ANTIERIOR AND POSTERIOR SACRAL ROOTS FOR RESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY

OBJECTIVE: To investigate an alternative procedure for complete denervation of bladder in the supra-cone cord injury to restore the bladder function. METHODS: Sixteen dogs were included in this study after their spinal cords were transected above the cone. They were divided into 6 groups and performed the rhizotomy of L7 to S3 root in different combination respectively. The bladder and urethra pressure change by electrostimulation during operation and cystometrogram change after operation were tested. RESULTS: 1. Electrostimulation study: for bladder innervation, S2was the most important and S1 was secondary. While for urethra innervation, S1 was more important than S2. When the anterior and posterior roots of S1 and S2 were intact with rhizotomy of posterior roots of L7 and S3, stimulated the common or posterior root of S1 and S2, the change of pressure in bladder and urethra was the same. When the anterior roots of S1 and S2 were resected with rhizotomy of posterior roots of L7 and S3, the pressure in bladder and urethra was significant decreased compared to stimulating the corresponding posterior roots. 2. Cystometrogram (CMG) study: in the complete deafferented group, resecting the posterior roots of L7 to S3, the bladder became flaccid. While resecting the posterior root of S2 and anterior root of S1 or, resecting the posterior root of S1 and anterior root of S2, combining with rhizotomy of posterior roots of L7 and S3, the CMG curve was similar to the complete deafferented group. In the S1 and S2 intact group, the bladder became spastic. CONCLUSION: Combining rhizotomy of anterior and posterior sacral root in different level has the same effects on bladder as complete deafferentation.

Expert consensus on multimodal assessment system for pelvic floor function

Female pelvic floor dysfunction (PFD) is a common disease affecting women's quality of life, especially in older women. The establishment and application of multimodal evaluation system is the key to the accurate diagnosis and effective treatment of PFD. The purpose of this expert consensus is to provide a comprehensive, multi-layered assessment framework that includes clinical examinations, imaging examinations, biomechanical tests, and questionnaires to comprehensively assess pelvic floor function in women. By integrating different assessment methods, we aim to improve the early identification and diagnostic accuracy of PFD, so that personalized treatment can be developed to improve patient outcomes. The consensus also discusses the advantages and disadvantages of various assessment techniques and suggests directions for future research and clinical applications.

Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials

Objective　To evaluate the effectiveness and safety of tension-free vaginal tapes (TVT) compared with Burch colposuspension for female stress urinary incontinence (SUI). Methods　We searched MEDLINE (1966 to October 2007), EMBASE (1988 to October 2007), Cochrane Central Register of Controlled Trials (1993 to October 2007), CMCC (1979 to October 2007) and CNKI (January 1979 to October 2007). We collected randomized controlled trials (RCTs) comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2 was used for data analyses. Results　Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Burch colposuspension as measured by the overall cure rate (OR 1.73; 95%CI 1.26 to 2.38; P=0.0007), negative stress test (OR 2.54; 95%CI 1.71 to 3.78; Plt;0.00001) and negative pad test (OR 1.67; 95%CI 1.16 to 2.41; P=0.006). The total complication rate was higher after TVT (OR 1.39; 95% CI 1.08 to 1.80; P=0.01), while the re-operation rate was significantly higher after Burch colposuspension (OR 0.29; 95%CI 0.10 to 0.80; P=0.02). The incidences of haematoma (OR 1.06; 95% CI 0.39 to 2.84; P=0.91), urinary tract infection (OR 1.27; 95% CI 0.64 to 2.52; P=0.50) and lower urinary tract symptoms (OR 1.20; 95% CI 0.89 to 1.62; P=0.23) were similar after TVT and Burch colposuspension. Conclusion　The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.