針對應力性尿失禁之女性，經閉孔尿道中段無張力陰道懸吊術的應用：單一醫學中心之經驗
歐詠豪1、葉忠信1,2、莊光達1,2、葉志胤1、蔡德甫1,2、林宜佳1,2、黃一勝1,2
新光吳火獅紀念醫院 外科部 泌尿科1
輔仁大學 醫學系2
Retrospective review on trans-obturator tension-free vaginal tape (TVT-O) for stress urinary incontinence: 3-year experience of a single center.
AO WENG HOU1, Chung-Hsin Yeh1,2, Guang-Dar Juang1,2, Chih-Yin Yeh1 , Te-Fu Tsai1,2, Yi-Chia Lin1,2, Thomas I.S. Hwang 1,2
Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital1
School of Medicine, Fu-Jen Catholic University2
Purpose:
Surgical treatments have a higher success rate than conservative therapy for stress urinary incontinence (SUI). Mid-urethral slings are the most frequently used procedure. We aim to report the 3-year efficacy and safety of trans-obturator tension-free vaginal tape (TVT-O) for women with SUI in a single center.
Materials and Methods:
From January 2016 to December 2018, 71 patients (mean age, 60.93±12.72 years) who underwent TVT-O for pure SUI were identified retrospectively. Patient with cystocele greater then grade II, combined other urological intervention with TVT-O and previous TVT-O were all excluded. Preoperative evaluation included subjective symptoms, objective assessment by urodynamic study (uroflowmetry and pressure-flow study). The mean operative time, hospital stay, intraoperative blood loss, subjective success rate defined as the absence of urinary leakage and adverse events were recorded.
Results:
The mean operative time was 36.56±13.61 minutes. The mean hospital stay was 4.08±0.53 days. The mean intraoperative blood loss was less than 50cc. The subjective success rate was 91.55% (n=65). The rate of postoperative lower urinary tract symptoms was 11.28% (n=8). 7.04% of patients (n=5) had postoperative difficulty urinating. Postoperative urine culture was positive in 9.86% of patients (n=7). One patient had intraoperative mesh protrusion into bladder with underlying disease of cervical cancer status post radical hysterectomy and radiation therapy, complication rate was 1.41%. The persistent urinary incontinence rate was 8.45% (n=6).
Conclusion:
TVT-O appears to be a safe and effective surgical treatment for female stress urinary incontinence with low complication rate. However, patient with unfavorable characteristic such as the gynecologic surgical history should be aware of possible complication.