許智凱、張廷瑞、陳世亮

台南市立醫院 泌尿科

Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Purpose: Mid-urethral sling is the gold standard as surgical treatment for female urinary incontinence. Transobturator tape (TOT) is the fashion method in recent decade, with a comparable dry rate for incontinence and lower complication rate to other sub-urethral sling procedures, such as TVT. Of the complications, the most unpredictable one is the post-operative urine retention. To prevent this complication, careful patient selection is required to exclude complicated SUI, those have bladder dysfunction and neurological deficit. Therefore, most physicians in medical center will arrange video urodynamic studies for screening patient’s underlying bladder function. In local hospitals, because of lacking urodynamic instruments, complete VUDS is not available for pre-operation screening. In this study, we used clinical assessment and post voiding residual urine (PVR) as screening tools, and report the surgical outcome and complication of TOT.

Materials and Methods: Female patients with stress urinary incontinence as a chief complaint was targeted. Detailed medical history and incontinence questionnaire was taken. Those has significant neurological deficits clinically was excluded, and PVR was check for every patient. PVR more than 200ml was considered as bladder dysfunction and an exclusion criteria for TOT surgery. TOT with AMS MONARC system was performed by single surgeon with general anesthesia and based on inpatient. Foley was removed at post-OP day 1, and PVR was checked. Patient will be discharged if no urine retention was observed. At outpatient follow up, PVR will be measured at day 7, and day 28. Remission rate of stress and urgent incontinence was analyzed at day 28. Adverse events and complications were recorded.

Results: From Sep. 2014 to Jan. 2016, total 21 patients received TOT. Age: 60.8(29~80). Children with vaginal delivery: 3.42(0~6). All 21 patients complaint of stress urinary incontinence, 10 of 21(47.6%) also has problem of urgent incontinence. 4 of 21 have diabetes, and 1 has history of old stroke. PVR measured at pre-operative: mean: 30.4(0~116)ml, at post-OP day 1: mean: 91.1(0~700)ml, day 7: mean: 39.6(0~100)ml, day 28: mean: 32.76(0~194)ml. Total dry rate: 81%, with SUI complete resolved in 20 of 21(95.2%), and UUI cured in 6 of 10(60%). Only 2 patients(9.5%) experienced AUR, but resolved in one week. No serious complication as bladder or vessel injury was noted. No statistical significant was noted between pre-operative PVR and post-operative PVR and AUR.

Conclusion: In our series as an experience of local hospital based practice. There is no statistical relationship between pre and post PVR. But when using PVR<200ml as a selection criteria, safety and excellent outcome of TOT is comparable to other studies.