关键词: 压力性尿失禁, 尿道下悬吊术, 尿动力学, 女性

Abstract:

Objective: To compare the changes of maximun flow rate and residual urine volume after tension-free vaginal tape (TVT) and trans-obturator tape (TOT) in the treatment of stress urinary incontinence in women. Methods: The clinical data of female patients with stress urinary incontinence who underwent transvaginal midsection tension-free urethral suspension in Peking University People' s Hospital from January 2022 to January 2024 were retrospectively analyzed. All the patients were followed up 1 month, 6 months and 12 months after surgery. Urodynamics were performed to evaluate urethral sphincter function before surgery. At the same time, B-ultrasonography was improved to determine the residual urinary volume of the bladder, and urgent incontinence, detrusor weakness and bladder outlet obstruction were excluded, and the diagnosis was clearly stress incontinence. Maximum flow rate and residual urinary volume were measured during follow-up, and combined with the urinary incontinence questionnaire of the International Urinary Incontinence Advisory Committee, the surgical effect was judged to be cured, improved or ineffective according to the degree of improvement of urinary leakage symptoms after surgery. Results: A total of 150 female patients with stress urinary incontinence were included in the study, the average age of the patients was (55.12±10.23) years old, and the follow-up time was 12 months. All patients completed postoperative follow-up, of whom 60 underwent TVT and 90 underwent TOT. The overall effective rates (cure + improvement) 1, 6, and 12 months after surgery in the TVT group were 93.3% (56/60), 91.7% (55/60), and 91.7% (55/60), and those in the TOT group were 92.2% (83/90), 90.0% (81/90), 90.0% (81/90), respectively, and there was no statistical difference between the two groups. The average maximum urinary flow rates 1, 6, and 12 months after surgery in the TVT group were (17.21±4.22) mL/s, (18.05±5.33) mL/s, and (18.37±4.92) mL/s, and those in the TOT group were (18.21±5.32) mL/s, (19.05±4.33) mL/s, and (19.27±4.92) mL/s, respectively, and there was no statistical difference between the two groups. The mean residual urine volume 1, 6, and 12 months after surgery in the TVT group was (13.21±5.22) mL, (18.25±5.33) mL, and (16.37±7.92) mL, and those in the TOT group was (11.21±6.32) mL, (13.05±5.33) mL, and (11.27±5.92)mL, respectively, and there was no statistical difference between the two groups. Compared with preoperative levels, there were no significant differences in the average maximum flow rate and the residual urine volume in both group at 1, 6, and 12 months after surgery. Conclusion: Both TVT and TOT are effective in the treatment of stress incontinence, and have no effect on postoperative maximum flow rate and residual urine volume.

Key words: Stress urinary incontinence, Suburethral slings, Urodynamics, Female