Clinical observation of the tension-free vaginal tape-obturator treatment for 130 cases of female stress urinary incontinence / 中国医师杂志

Objective To observe the clinical short-and long-term curative effect of the surgical treatment of female stress urinary incontinence (SUI) with tension-free vaginal tape-obturator (TVT-O) treatment,and discuss the safety of the operation and postoperative quality of life.Methods The data were collected from 130 patients with SUI who were underwent TVT-O treatment.The patients'perioperative period,follow-up of postoperative complications,and comparison of the quality of life before and after surgery were analyzed retrospectively.Results A total of 130 patients was successfully completed their surgeries with a mean operative time (47.01 ± 18.82)min,average blood loss (64.38 ±99.62)ml,mean catheterization (2.67 ±0.90)d,and the average length of stay (4.73 ±2.14)d.A total of 101 cases was completed the postoperative follow-up with (a) preoperative quality of life in patients with ⅡQ-7 score 6 to 21 points and an average of (15.74 ± 3.87) min,(b) symptoms of lower urinary tract UDI-6 score of 3 to 22 minutes and the average (10.51 ± 3.70) min,(c) postoperative quality of life improved significantly ⅡQ-7 score from 0 to 21 points and an average of (1.59 ±4.37)points,and (e) UDI-6 score 0 to 14 points and an average of (1.63 ± 2.66)points.A total of 73 patients (72.3％) had the postoperative urinary incontinence,which subjective symptom were completely cured,significant improvement was 11 cases (10.9％),ineffectiveness was 6 cases (5.9％),pad using was 13 patients (12.9％),vaginal mesh exposure and erosion was 2 patients(2.0％),the sexual life postoperatively was affected in 8 patients (7.9％).Conclusions TVT-O treatment of SUI is not only easy to operate but also has clinically high security,few complications,low recurrence rate,and significantly improved patients' living quantities.However,patch compli cations can not be ignored and need further discussion.

Neocolpoplastia com alça exclusa de sigmóide / Neocolpoplasty with excluded sigmoid segment

Introdução: O emprego de alças intestinais para tratamento de agenesia de vagina remontaao início do século vinte, porém tem sido pouco popularizado. Método: Os autores apresentamsete casos em que a neocolpoplastia foi realizada com o emprego de alça exclusa desigmóide, transposta através do fundo de saco de Douglas, por incisão peritoneal, e alojadaem um túnel dissecado entre o reto e a bexiga. A extremidade inferior foi suturada ao intróitovaginal com incisão quebrada em V, e a extremidade superior fechada em fundo cego, ousuturada ao redor do colo uterino telescopado através dela, quando o útero estava presente.Resultados: A evolução é de três a dez anos. A técnica foi executada em três casos comausência de vagina associada à agenesia de útero, um caso de síndrome adrenogenital comatresia de vagina associada a útero infantil, e três casos de agenesia de vagina com presençade útero funcional. O útero foi preservado, com seu colo dentro da neovagina, permitindomenstruações normais em dois deles. Discussão: Não foram necessários, nem indicados,dilatações ou uso de moldes no período pós-operatório. Os resultados foram bons e o índicede complicações pequeno. As vaginas permitem penetração fácil. São amplas, profundas eelásticas, com lubrificação e aspecto visual normais. Conclusão: A neocolplastia mostrouseuma técnica viável com baixo índice de complicação, principalmente estenoses.

Introduction: The use of intestinal loops for treatment of vaginal agenesis remounts to thebeginning of XX century; however it has been little popularized. Methods: The authorspresent seven cases wherein the neocolpoplasty has been realized with the use of excludedsigmoid loop, transposed trough the bottom of Douglas sack by peritoneal incision andaccommodated in a dissected tunnel between the rectum and the bladder. The inferiorextremity was sutured to the vaginal introit with incision in V, and the superior extremityclosed in a blind bottom, or sutured around of the telescoped uterine cervix trough her, whenthe uterus was present. Results: The evolution is from three to ten years. The techniquewas executed in three cases with vagina absence associated to the uterus agenesis, onecase of adrenogenital syndrome with the vagina atresia associated to an infantile uterus,and three cases of vaginal agenesis with the presence of functional uterus. The uterus waspreserved with his lap inside of the neovagina, allowing normal menstruation in two ofthem. Discussion: Weren’t necessary, not even indicated, dilations or use of molds in thepostoperative period. The results were good and the index of complications was small.The vaginas allow easy penetration. They are ample, deep and elastic, with lubrication andnormal visual aspect. Conclusion: The neocolpoplasty show it to be a viable techniquewith low complication index, mainly estenoses.