陰道單一切口尿道中段吊帶手術的初步經驗
錢家陞、沈元琦、莊燿吉
高雄長庚紀念醫院 外科部 泌尿科
Primary experiences of single incision midurethral sling in women with stress urinary incontinence
Chia-Shen Chien, Yuan-Chi Shen, Yao-Chi Chuang
Department of Urology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose: We present our preliminary experience of single-incision mid-urethral sling (ADJUST and MiniArc) in women with stress urinary incontinence (SUI).
Materials and Methods: Four patients had mixed urinary incontinence (MUI) and the other 4 had only SUI, while one of them had concomitant cystocele. Half of the patients with MUI and SUI received ADJUST while MiniArc was applied for the others. Cystocele was repaired simultaneously with anterior Elevate system. Subjective cure was defined as no report of leakage with coughing or exercise on validated International Consultation on Incontinence Questionnaire-Urinary Leakage-Short Form (ICIQ-UI-SF). Operation time, Foley indwelling time, hospital stay, perioperative postvoid residual urine (PVR) and uroflow study were documented as well.
Results: Significant subjective improvement of urinary incontinence was observed in all patient groups. Only one patient had prominent PVR (110ml) after ADJUST sling surgery but no eminent decrease of Qmax. Another patient self-reported as symptoms improvement instead of cure due to persistent urinary urgent incontinence (UUI). MiniArc claimed shorter operation time (from 10 min to 20 min), while ADJUST sling needed a longer operation time (from 20 min to 30 min). Foley was removed one day after operation except in patient with combined cystocele repaired (Foley removed 2 days after operation).
Conclusion: The current primary results showed optimal outcome of subjective improvement in patients with SUI or MUI with mean follow up between 1 month to 1 year. Modern single incision sling is easy to perfrom without significant complications. Further objective outcomes and longer follow-up are needed to draw the conclusions.