Tension-Free Vaginal Tape in the Management of Recurrent Urodynamic Stress Incontinence after Previous Failed Midurethral Tape
Tension-Free Vaginal Tape in the Management of Recurrent Urodynamic Stress Incontinence after Previous Failed Midurethral Tape
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DOI：
10.1016/j.eururo.2009.03.025
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发表时间：
2009-06-01
期刊：
影响因子：
23.4
通讯作者：
Creatsas, Georgios
中科院分区：
文献类型：
--
作者：
Liapis, Angelos;Bakas, Panagiotis;Creatsas, Georgios
背景：关于使用无张力阴道胶带 (TVT) 治疗尿道中段悬吊术 (MUSP) 失败后复发性尿动力学压力性尿失禁 (RUSI) 的数据有限。 目的：评估 TVT 手术治疗先前 MUSP 失败后 RUSI 患者的疗效和适应症。 设计、设置和参与者： 31 名 RUSI 患者， MUSP 失败者前瞻性地在单一三级学术中心入组。 测量：术前和术后，对患者进行体格检查、尿液分析、尿培养、2-3 d 膀胱日记、棉签测试、尿流率、充盈和排尿性膀胱测量、尿道轮廓测量和 1 小时垫测试进行评估。平均随访时间为 18.6 个月（范围：12-28 个月）。 结果和局限性：总体而言，基于垫测试结果的客观治愈率为 74%，改善率为 6.5%，失败率为 19.5%。充盈性膀胱测压时基于咳嗽应激试验的客观治愈率为77.4%，基于患者回答的主观治愈率为71%。该研究可能存在一些局限性。入组患者数量相对较少可能会在一定程度上影响研究结果。此外，由于当使用侧孔微尖传感器时，尿道压力曲线显示出显着程度的方向依赖性，如本研究所示，传感器的方向可能会影响测量值。 结论：对于先前尿道中段胶带手术失败后的 RUSI 女性患者，TVT 手术作为第二次手术可以提供 74% 的总体治愈率，且并发症发生率较低。 (C) 2009 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Background: Data about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited.Objective: Assessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP.Design, setting, and participants: Thirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center.Measurements: Preoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2-3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6 mo (range: 12-28 mo).Results and limitations: Overall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients' answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured.Conclusions: The TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.