自体尿道中段筋膜吊带治疗压力性尿失禁的远期疗效

T. Malthouse, I. Rudd, C. Down, James A Moore
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引用次数: 0

摘要

人们对压力性尿失禁(SUI)的无网格手术选择越来越感兴趣。传统上,直肌筋膜自体吊索被放置在膀胱颈,但最近它们被放置在尿道中段(aMUS)。描述了这些患者的长期结果。对2009-2014年间由一名外科医生对原发性SUI的aMUS患者进行了回顾性分析。术前对所有患者进行尿动力学评估。患者报告的结果是通过邮寄问卷收集的,使用ICIQ-UI简式问卷、7分整体改善印象评分、衬垫使用问题、自导尿管、膀胱过度活动治疗和再手术率。结果包括31名患者(有效率63.8%),中位年龄49岁,中位BMI 27。27%的患者术前有压力性混合性尿失禁。中位随访时间为8年(5-11年);60%的患者是干燥和无衬垫的。77%(77%)的人发现手术使生活质量“大大改善”或“非常改善”。13%(13%)的患者报告生活质量下降。ICIQ-UI简表得分中位数为5.5。16.7%的患者正在服用药物,1名患者因膀胱过度活动症状接受肉毒杆菌毒素治疗。所有患者术前尿动力学检查均为混合性尿失禁。再次手术率为13.3%,其中1例为自置管。31人中有3人(10%)经历过骨盆疼痛,31人中的2人(6%)经历过性交困难。AMUS显示出良好的长期控尿效果,并与较低的新发膀胱过度活动症状和排尿功能障碍发生率有关。
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Autologous mid-urethral fascial sling for stress urinary incontinence: Long term outcomes
There has been an increasing interest in mesh-free surgical options for Stress Urinary Incontinence (SUI). Traditionally rectus fascia autologous slings were placed at the bladder neck but more recently they are positioned at the mid-urethra (aMUS). The long-term outcomes for these patients are described. A retrospective analysis of aMUS patients between 2009-2014 by a single surgeon for primary SUI was performed. All patients were evaluated preoperatively with urodynamics. Patient reported outcomes were collected via postal questionnaire using the ICIQ-UI short-form questionnaire, 7-point Global Impression of Improvement score, questions on pad usage, self-catheterisation, overactive bladder treatment and re-operation rates. Results included 31 patients (response rate 63.8%). The median age was 49 years and median BMI was 27. Twenty-seven per cent (27%) of patients had stress predominant mixed urinary incontinence pre-operatively. Median length of follow up was 8 years (5- 11); 60% of patients were dry and pad-free. Seventy-seven per cent (77%) found the surgery led to “much improvement” or “very much improvement” in quality of life. Thirteen per cent (13%) of patients reported a deterioration in quality of life. The median ICIQ-UI short form score was 5.5. 16.7% were taking medication and 1 patient received botulinum toxin therapy for overactive bladder symptoms. All these patients had mixed urinary incontinence on preoperative urodynamics. The re-operation rate was 13.3%. One patient was selfcatheterising. Three out of 31 (10%) had experienced pelvic pain, with 2 out of 31 (6%) experiencing dyspareunia. AMUS shows good long-term continence outcomes and is associated with low rates of de-novo overactive bladder symptoms and voiding dysfunction.
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来源期刊
Urogynaecologia International Journal
Urogynaecologia International Journal Medicine-Obstetrics and Gynecology
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