Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT)
Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT)
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DOI：
10.1080/791201837
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发表时间：
2001-01-01
影响因子：
4.3
通讯作者：
Soong, YK
中科院分区：
文献类型：
--
作者：
Lo, TS;Wang, AC;Soong, YK
背景。本研究旨在评估无张力阴道胶带（TVT）治疗压力性尿失禁后的尿动力学和超声检查结果。90例无盆腔松弛综合征的压力性尿失禁妇女接受手术治疗。术前及术后1年行尿动力学测量、1小时尿垫试验及尿道超声评价，术后立即行尿道超声监测。对比术前和术后膀胱颈相对耻骨联合下缘的位置和活动度。8名妇女因各种原因被排除在外。在完成研究的82名妇女中，76人（93%）治愈，4人好转，2人失败。没有发生重大的手术内或术后并发症。手术前后膀胱颈的位置和活动度无明显差异。在最大张力状态下，对已治愈和改善的患者进行超声检查，观察其尿道膝关节角度。9例术后立即排尿困难的患者发现有明显的尿道中角。经尿道减压后症状和体征随时间逐渐消失。除70例（87.5%）治愈和好转患者在尿道中段出现正压传递外，其余尿动力学评价结果与术前、术后无显著差异。阴道无张力胶带手术是治疗女性压力性尿失禁的有效手术方法。手术似乎既不能改变过度活动，也不能提高膀胱颈的位置。手术后尿失禁很可能是通过创造一个动态的尿道中膝关节角度来实现的，通过这个角度，尿道被关闭，即在压力下扭结。抬高中尿道导致术后排尿困难。重要的是要把胶带放在尿道下面，不要有张力。心内超声监测是观察手术结果的一种合适的技术。
Background. This study was carried out to evaluate the urodynamic and ultrasonographic findings after tension-free vagina tape (TVT) procedure on stress urinary incontinent women.Methods. Ninety women sufft ling From genuine stress incontinence without pelvic relaxation syndrome underwent surgery. Urodynamic measurement, one-hour pad test and introital ultrasonographic evaluation were performed preoperatively and one year after surgery Additional ultrasonographic surveillance of the urethra was performed immediately after the operation. The position and mobility of the bladder neck was compared pre- and post-operatively in relation to the inferior edge of the pubic symphysis.Result. Eight women were excluded for various reasons. Among the 82 women who completed the study 76 (93%) were cured, four were improved and two failed. No major intra- or postoperative complications occurred. The position and mobility of the bladder neck showed no significant difference before and after surgery. A urethral knee angle was noted ultrasonographically on cured and improved patients during maximum straining. Nine patients with immediate postoperative voiding difficulty were found to have a pronounced mid-urethra angulation. The symptom and sign were resolved by time after urethra depressing. Urodynamic assessment of the urethral pressure profile and other parameter showed no significant difference before and after the surgery except that a positive pressure transmission in the middle portion of the urethra was noted among 70 (87.5%) of cured and improved subjects.Conclusion. Tension-free vagina tape operation is an effective surgical procedure for the treatment of female urinary stress incontinence. The procedure seems neither to change hypermobility nor to elevate the position of bladder neck. Urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed i.e. kinked at stress. Lifting of the mid-urethra resulted in postoperative voiding difficulty. It is the important that the tape is placed tension free under the urethra. Introital ultrasonographic surveillance is a suitable technique to visualize the result of the operation.