Clinical observation of adjusting middle urethral sling tension through anatomic position during RMUS / 中华泌尿外科杂志

Objective:To investigate the safety and effectiveness of tension adjustment technique using anatomical landmarks during retropubic midurethral synthetic sling.Methods:The data of 36 consecutive female patients with urinary incontinence, who had underwent retropubic midurethral synthetic sling procedure from January to August 2019 were analyzed retrospectively. The mean age was (60.83±7.93) years old and the body mass index was (24.43±2.44) kg/m 2. Among the recruited subjects, 36 had positive stress test and Marshall-Marchetti test. 20 (55.6%) were pure stress urinary incontinence, and 16 (44.4%) were mixed urinary incontinence. The severity of incontinence was classified into mild (5 cases, 13.9%), moderate (14 cases, 38.9%), severe (13 cases, 36.1%) and very severe (4 cases, 11.1%) using one-hour pad tests. Urodynamics were performed in 17 cases, with 5 (29.4%) presented detrusor overactivity, 3 (17.7%) possessed intrinsic sphincter deficiency. For each case, the tension of the sling was adjusted based on the anatomical landmarks, i. e. using an angled clamp attached closely to the pubic symphysis ventrally and the tip parallel to the edge of hymen dorsally. All patients were catheter-free right after the procedure. The subjective and objective effectiveness, and safety (the rate of urinary retension after surgery and postvoid residual volume 3 months later) were evaluated.The subjective cure rate was was defined as complete leakage free or very mild leakage during excessive bladder filling and fierce cough. The subjective effectiveness was defined as over 50% improvement of the leakage symptom. The objective cure rate was defined as a negative stress test. Results:For all 36 patients, the median hospital stays was 8 (5-95)h. No bladder perforation or transfusion cases. All patients were catheter-free right after the procedure, with no incidence of urinary retention. 27 patients completed a 3-month follow-up, with 22 had post-void residual data, 23 had subjective effectiveness data and 23 had objective effectiveness data. The median post-void residual was 7.5 (5-64) ml, subjective cure rate was 91.3% (21/23), and objective cure rate was 95.7% (22/23). 8.7% (2/23) reported difficult urination alleviated without the necessity of clinical interference. No urethra erosion or vagina extrusion was found. At 2-year follow-up, 34 patients completed assessment by phone. The subjective cure rate was 91.2% (31/34), with only 2.9% (1/34) reported difficult urination. Besides, at 3-month follow-up, there was no difference regarding the subjective cure rate [100.0%(12/12) vs. 81.8%(9/11)]or objective cure rate [91.7%(11/12) vs. 100.0%(11/11)] between patients with stress and mixed incontinence. No difference was noted among patients with mild, moderate, severe and very severe leakage[75.0% (3/4) vs. 100.0%(6/6) vs. 90.0%(9/10) vs. 100.0%(3/3)]. Of the 12 cases with urodynamic records, the presence of detrusor overactivity [66.7%(2/3) vs. 88.9%(8/9)] or intrinsic sphincter deficiency [0(0/1) vs. 90.9%(10/11)] did not significantly affected the cure rate of the procedure. At 2-year follow-up, there was no difference regarding the subjective cure rate between patients with stress and mixed incontinence [94.7%(18/19) vs. 86.7%(13/15)]. No difference was also noted among patients with mild, moderate, severe and very severe leakage[80.0%(4/5) vs. 100.0%(13/13) vs. 83.3%(10/12) vs. 100.0%(4/4)]. Of the 16 cases with urodynamic records, the presence of detrusor overactivity [60.0%(3/5) vs. 90.9%(10/11)]or intrinsic sphincter deficiency [66.7%(2/3) vs. 84.6%(11/13)]did not significantly affected the cure rate of the procedure.Conclusions:Tension adjustment using anatomic landmarks during sling procedure is safe and feasible for urinary incontinence, with minimum complications and residual volume, and high subjective/objective cure rate.

Changes of abdominal wall mechanics and pain after tension-free inguinal hernia repair with polypropylene mesh / 中国组织工程研究

BACKGROUND: Chronic pain after tension-free inguinal hernia repair is a common postoperative complication. An important cause of chronic pain is nerve injury. OBJECTIVE: To observe the effect of iliohypogastric nerve preposition on chronic pain after inguinal hernia repair and analyze its mechanics. METHODS: Totally 76 male inguinal hernia patients, from August 2013 to November 2016, aged 36-95 years in Second People’s Hospital of Lianyungang were selected. The patients were all treated with large-size polypropylene non-absorbable mesh insertion. The iliohypogastric nerve was placed in front of the mesh. Pain was followed up at 3, 6, and 12 months after operation. This study was approved by the Ethics Committee of Second People’s Hospital of Lianyungang. RESULTS AND CONCLUSION: (1) No chronic pain or recurrence was found in the 76 patients at 3, 6 and 12 months after surgery. (2) The pressure included vertical pressure and tangent pressure formed from intra-abdominal pressure on abdominal wall, directly affecting abdominal wall and artificial repair materials. This was the basic cause of the relative mechanical relationship between nerve and mesh. (3) The results showed that the tension-free inguinal hernia repair with the iliohypogastric nerve preposition could reduce the incidence of postoperative chronic pain, which may be related to the effect of postoperative abdominal pressure on tissue repair, especially the repair around the mesh.

Large Meningomyelocele Defects Reconstruction Using Double Opposing Fasciocutaneous Flaps

When a part of neural tube fails to develop or close properly, it manifests as spina bifida. Spina bifida defects range from the mild form (spina bifida occulta) to severe form (meningomyelocele). Meningomyelocele is to be closed surgically as early as possible to prevent infection and other complications. Many methods are available for treatment of meningomyelocele defects ranging from skin graft to flap cover. Meningomyelocele defects when small in size can be closed primarily. Large meningomyelocele defects poses technical challenge to reconstructive surgeon. Many flap cover techniques were described to cover the large meningomyelocele defects. We wanted to evaluate bilateral opposing fasciocutaneous flaps method for closure of large defects without tension.METHODSTo cover large meningomyelocele defects, fasciocutaneous flaps give good and stable cover, and prevents wear and tear, and infections. We have used double opposing fasciocutaneous flaps method for reconstruction of large meningomyelocele defects. The advantages of this technique are its simplicity and it being a single stage procedure. 20 children with meningomyelocele defects of various sizes were operated with this method and followed for 6 months for wound dehiscence and CSF leak.RESULTSClosure of large meningomyelocele defects is made possible with simple and easy technique. Ease of planning and execution even for the inexperienced are the most noticeable features. All children were well post operatively. Two patients in whom flaps were taken with acute angles suffered tip necrosis. All flaps gave stable cover to the defect without dehiscence at the suture line. The entire reconstructive process consumed less time and was without major complications.CONCLUSIONSNeural tube malformation congenitally causes spina bifida defects. Spina bifida cases may range from simple to severe defects. Treatment of meningomyelocele spans from primary closure to flap cover closure. Closure of large meningomyelocele defect by bilateral fasciocutaneous flaps is a good method to adopt. This method is simple, less time consuming, technically non-demanding and easily reproducible.

Evaluation of a 3D printed female anatomical model for the hands on training of trans-obturator tape (TOT) and tension free vaginal tape (TVT) sling procedures / Evaluación de un modelo anatómico femenino impreso en 3D para el entrenamiento práctico de los procedimientos de cinta trans-obturadora (TOT) y cinta vaginal sin tensión (TVT)

Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.

Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.

A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

Research progress of patch infection after tension-free hernia repair / 解放军医学杂志

Inguinal hernia is one of the common diseases in general surgery, and tension-free hernia repair is the most common treatment for inguinal hernia. Patch infection is the common complication after hernia repair, confuses many of the general surgeons for its complex condition and long duration. The pathogenetic factors of patch infection can be roughly divided into three aspects, which include patients' physical condition, operation details, material and structure of patch. Prevention in advance of the susceptible factors of mesh infection can significantly improve the prognosis of patients. As for the treatment of patch infection, there is no unified standard yet, and individual treatment plans should be formulated according to the patient's condition and experience of the clinician. This article reviews the latest research progress of the occurrence, diagnosis, prevention and treatment of patch infection after tension-free hernia repair.

The problems of mesh repair and the value of tissue repair in the treatment of groin hernia in young people / 中国实用外科杂志

The World Health Organization defines youth as 14 to 25 years old, and the inguinal hernia patients in this age group are still in the development stage of the body with special physiological characteristics and special needs for the protection of reproductive functions. Therefore, the repair method should be carefully selected for the special group and the principle of individualized treatment should be adhered to.The synthetic mesh has problems such as failure to extend with body growth, excessive scar hyperplasia compressing the spermaduct, and long-term invasion. The biological patch also has the risk of long-term recurrence or local bulging. For youth, standard tissue repair surgery can mending the defect well, with reasonable perioperative management, also can minimize the discomfort, which caused by excessive early postoperative tension. At the same time, tissue repair can adapt to the growth of the body, with relatively small impact on reproductive function, or can be combined with biological materials to repair large defects if necessary. After mastering tissue repair technology, the recurrence rate of tissue repair is acceptable. Therefore, tissue repair is of irreplaceable value in the treatment of young inguinal hernia patients.

Controversy, consensus and reasonable choice of application of mesh in treatment of inguinal hernia in adolescents / 中国实用外科杂志

The adolescent inguinal hernia has particularity in modern surgical treatment. Because of in the stage of growth and development, it can not be used only for the inguinal hernia sac high ligation, nor can it be treated as an adult inguinal hernia with artificial synthesis material mesh.Therefore, there are still many disputes in adolescent inguinal hernia treatment. As a kind of absorbable material, biologic mesh can repair inguinal hernia defect and induce the growth of cells and fibrous tissue to repair the defect of the inguinal wall. It can be degraded and absorbed by the body after the repair of the defect by the proliferation of autologous tissue,which does not affect the growth and development of adolescents,and its advantages have been affirmed by more scholars. Biologic mesh has become an ideal choice for the repair of inguinal hernia in adolescents.

Analysis of clinical effect on 19 cases of inguinal hernia treated by laparoscopic totally extraperitoneal repair / 国际外科学杂志

Objective To investigate the effect of laparoscopic total extraperitoneal tension-free hernia repair (TEP) in the treatment of inguinal hernia with absorbable biological mesh.Methods A retrospective analysis of the clinical data of 19 patients with inguinal hernia with biological mesh was performed from September 2015 to September 2016 in Shengjing Hospital of China Medical University.The average operative time,average incision pain time,average postoperative venting time,average hospital stay,average operative cost,and long-term chronic pain,postoperative complications,and recurrence rate were observed.Results All the 19 patients were successfully operated.The average operation time was (35.0 ± 4.0) min,the average incision pain time was (1.5 ± 0.6) d,and the average postoperative venting time was (1.5 ± 1.2) d.The average hospital stay was (4.5 ±0.9) d,the average surgery cost was (23 534.6 ± 1 259.9) yuan.Two patients developed swelling of the scrotum after surgery,and one patient developed postoperative fat liquefaction.All patients were followed up for 1 year by telephone,with no recurrence,no serious complications,and chronic pain discomfort.Conclusions The application of absorbable biopsy TEP is a good and reliable way to treat inguinal hernia.Postoperative patients have mild pain and low complication rate.There is no recurrence in recent follow-up,and the short-term effect is satisfactory.It is a reliable method for the treatment of inguinal hernia.The cost is high,and can be selected according to age and individual needs.

Incidence and influence factors analysis of chronic postoperative inguinal pain after tension-free repair for inguinal hernia / 中华消化外科杂志

Objective To investigate the incidence and influence factors of chronic postoperative inguinal pain (CPIP) after tension-free repair for inguinal hernia.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 188 patients who underwent tension-free repair for inguinal hernia in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2011 and August 2017 were collected.Observation indicators:(1) surgical and postoperative situations;(2) follow-up;(3) influence factors analysis of CPIP.Follow-up using outpatient examination and telephone interview was performed to detect inguinal pain and complications at 1,3,6 months and 1 year postoperatively up to August 2018.Measurement data with normal distribution were represented as x ±s.Measurement data with skewed distrubution were described as M (range).The univariate and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical and postoperative situations:1 188 patients underwent successful tension-free repair for inguinal hernia.Eighty-five patients (7.155％,85/1 188) had CPIP,including 76 (8.370％,76/908) undergoing open surgery and 9 (3.214％,9/280) undergoing laparoscopic surgery.(2) Follow-up:1 188 patients were followed up for 12-36 months,with a median time of 19 months.Incidence rates of CPIP with visual analogue score ＞ 3were 11.785％(140/1 188),7.155％(85/1 188),5.808％(69/1 188),3.199％(38/1 188) at 1,3,6 months and 1 year postoperatively.Patients were given individualized and reasonable treatment according to their own conditions and CPIP was relieved after conservative treatment including drug treatment,physiotherapy such as acupuncture,nerve block and psychotherapy.Of 5 patients with CPIP after tension-free repair for inguinal hernia undergoing surgeries,1 was relieved nerve ligation by surgery,3 with mesh related pain were removed meshes,1 was taken the fixed stiches out.They were relieved CPIP after above treatments.During the follow-up,161 patients with incisional seroma,75 with incisional infection and 5 with disruption of wound were cured by symptomatic treatments including reinforced incision management,dressing change and physiotherapy.Seven patients with mesh infection were removed meshes.Of 68 patients with hernia recurrence,53 had reoperation,18 complicated with diseases induced severe increased intra-abdominal pressure were suggested to undergo surgeries after treatment of complications.(3) Influence factors analysis of CPIP:① results of univariate analysis showed that sex,age,bodymass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were related factors affecting CPIP after tension-free repair for inguinal hernia (x2 =21.002,6.715,6.012,8.563,11.887,49.447,10.025,P＜0.05).② Results of multivariate analysis showed that sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were independent related factors affecting CPIP after tension-free repair for inguinal hernia (odds ratio =1.267,2.986,1.661,3.208,2.034,1.871,95％ confidence interval:1.042-1.392,1.372-4.901,0.998-2.758,1.933-6.013,1.556-3.118,1.095-3.534,P＜0.05).Conclusions Sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection are independent related factors affecting CPIP after tension-free repair for inguinal hernia.Preoperative pain management and psychological counseling,intraoperative refine performance,inguinal nerve protection and postoperative incisional management should be reinforced to prevent and reduce incidence of CPIP.

Clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenviron-ment related indicators / 实用医学杂志

Objective To investigate the clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenvironment related indicators in patients.Methods A total of 128 cases of patients with inguinal hernia admitted in our hospital were divided into control group and observation group with 64 cases in each group.The control group was treated with traditional hernioplasty,while the observation group mesh plug ten-sion-free hernia repair.The clinical effect and microenvironment related indicators 1d after the operation were com-pared between the two groups. Results Compared with the control group,the observation group had less blood loss during the surgery,and shorter time for recovery of out-of-bed ambulation and hospitalization(P<0.01),but no significant difference was found regarding surgery hours(P > 0.05). The VAS scores of the observation group were significantly lower than those of the control group at the same time points 1 and 3 days after operation(P <0.01). Compared with those of control group 1 day after operation,the serum beta-endorphin(β-EP)of observa-tion group was significantly reduced,but total antioxidant capacity(T-AOC),growth hormone(GH),insulin (InS)level increased significantly(P<0.01).Serum matrix metalloproteinases-9(MMP-2 and MMP-9)and tis-sue inhibitor of matrix metalloproteinases(TIMP-1 and TIMP-2)were significantly reduced(P<0.01).Acute uri-nary retention,scrotal effusion,the incidence of postoperative pain and postoperative recurrence rate of observa-tion group were significantly reduced when compared with those of control group(P < 0.01);there was no differ-ence of incidence of low thermal between the two groups(P>0.05).Conclusion Mesh plug tension-free hernia repair has a significant clinical effect on inguinal hernia with less complications,lower recurrence rate and lighter impact on microenvironment related indicators.

Effect of Collagen Thread in Tension-Free Suture of Oral Implant Surgical Incision and Effect on Wound Healing Time / 昆明医科大学学报

Objective To investigate the effect of collagen line in the tension－free suture of the incision of oral implant and the effect on the healing time of the wound. Methods 100 patients were selected from January 2016 to January 2017 for repair of dental implant in Zhong Hua Dental clinic of Jinghong city, and they were randomly divided into control group and study group,with 50 cases in each group. The control group was treated with non absorbable sutures of silk suture wounds, while the study group using collagen suture wounds, then we compared two groups of patients with wound healing grade, suture line absorption, wound healing time and formation rate. Results The research group of grade A healing rate was 96%, significantly higher than 80% in the control group (P＜0.05), and the adverse reactions of the study group was 6%, lower than 20% in the control group (P＜0.05);the complete absorption rate and smooth incision rates in the study group for suture in different times were 84%, 96% 100%, and 86%, which were significantly higher than the control group's 62%, 78%, 80% and 68% (P＜ 0.05) . The wound's healing time and postoperative VAS score of 3 d, 5 d and 7 d were significantly lower than the control group (P＜0.05) . Conclusion Collagen line in oral implant surgery incision tension－free suture of wound healing and postoperative recovery is significantly better than that of silk and non absorbable sutures, and collagen can be degradated orally,which effectively improves the wound healing of patients with grades and wound flat rate, and effectively accelerates wound healing, with the value of application.

Modified transobturator tape for female stress urinary incontinence / 中华泌尿外科杂志

Objective To explore the efficacy and safety of modified transobturator tape (TOT) for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group) and 52 patients underwent modified TOT operation (modified TOT group),were retrospectively reviewed.There was no statistical difference of age [(59.7 ± 10.3) yea~ vs.(56.3 ± 9.1) years],BMI [(24.I ± 9.7) kg/m2 vs.(24.6 ± 9.3) kg/m2],diabetes history [31.4％ (11/35) vs.26.9％ (14/52)],mixed urinary incontinence [45.7％ (16/35) vs.48.1％ (25/52)] and the daily amount of urine pad [(4.3 ±2.7) vs.(3.9 ± 2.1)] between the two groups (P ＞ 0.05).The operative time,intraoperative complications,and postoperative complications were collecteded in two groups.Patients were followed up at 3 months,6 months,and 1 year after surgery.Results There was no significant difference in operation time [(21.1 ± 4.3) min vs.(20.5 ± 5.7) min],intraoperative hemorrhage [(18.3 ± 9.1) ml vs.(25.7 ± 8.3) ml] and postoperative incidence of urinary retention [2.9％ (1/35) vs.3.8％ (2/52)] between the two groups (P ＞ 0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group[1.9％ (1/52) vs.20.0％ (7/35),P ＜ 0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3 months,6 months and 1 year after surgery (P ＞ 0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.

To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient / 中华老年医学杂志

Objective To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient.Methods A total of 124 elderly patients with inguinal hernia admitted in our hospital in 2016 were randomly divided into a study group(n=62)and a control group (n=62).The control group was treated with open tension-free inguinal hernia repair,whereas with laparoscopic tension-free inguinal hernia repair in the study group.The operation time,intraoperative blood loss,the postoperative pain relief-time,mean days of hospitalization,postoperative recurrence rate,and complications rates were compared between the two groups.Results The more significant improvements were found in study group versus control group in the intraoperative bleeding volume [(19.9±2.0)ml vs.(36.8±-2.5)ml,t=41.564,P=0.000],in the mean hours of postoperative pain [(22.1 ± 4.2) h vs.(35.3 ± 7.0) h,t =12.732,P =0.000],in mean days of hospitalization [(5.5 ± 1.0)d vs.(9.2±1.9)d,t=13.569,P=0.000],in incidence rate of postoperative recurrence(0.0％ vs.6.5％,x2 =4.133,P=0.042),and in postoperative complications rate(3.2％ vs.12.9％,x2 =3.916,P=0.048).Nevertheless,the operation time was longer in the study group than in the control group[(87.0±5.0)min vs.(55.5±4.2)min,t=-37.984,=0.000],Conclusions As compared with open tension-free repair,the clinical efficacy of laparoscopic tension-free hernia repair is exactly sure in the treatment of inguinal hernia,with shorter postoperative hospitalization time and lower incidence of complications.

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI). METHODS: We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O. RESULTS: A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01). CONCLUSIONS: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.

A control study on the clinical outcome of tension-free vaginal tape-obturator and modified tension-free vaginal tape-obturator for female stress urinary incontinence / 西安交通大学学报(医学版)

ABSTRACT:Objective To evaluate the curative effect of tension-free vaginal tape-obturator (TVT-O)and modified TVT-O in treating female stress urinary incontinence (SUI).Methods We selected 1 1 3 female patients diagnosed with SUI from January to December 2013 in our department and divided them into standard TVT-O group (group A,5 6 cases)and modified TVT-O group (group B,5 7 cases).We evaluated prospectively the safety,short-term efficacy and complications of operation in the two groups.Results The length from bilateral obturator membrane to the puncture point in the skin was greater in group A than in group B.The average intraoperative blood loss was more in group A than in group B.The median NRS score of postoperatie thigh pain in group A was higher than in group B (P0.05).Conclusion Both TVT-O and modified TVT-O techniques are effective in treating female SUI.Modified TVT-O has a short path to get through the adductor muscles and less intraoperative blood loss;therefore,it can significantly reduce the complications such as postoperative pain to enhance the quality of life after operation. 

Clinical comparative analysis of Laparoscopic transabdominal preperitoneal repair and path tension -free ;hernioplasty in the treatment of recurrent inguinal hernia in adults / 中国基层医药

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP)and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults,and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia.Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time,intraoperative bleeding volume,postoperative hospitalization time,cost of hospitalization,postoperative complications,early postoperative pain and the recurrence of hernia were compared between the two groups.Results All patients were successfully completed surgery.The operation time of TAPP group (47.2 ±9.4)min was significantly shorter than (73.1 ±10.4)min of Lichtenstein group (t=-2.503,P=0.034).The median amount of bleeding during operation of TAPP group was 40(15 -110)ml,which was significantly less than 73(11 -130)ml in Lichtenstein group (t=-6.018,P=0.000). Postoperative hospital stay of TAPP group[(6.5 ±1.4)d]was shorter than (8.2 ±1.6)d of the Lichtenstein group (t=-2.613,P=0.028).Early postoperative pain score of TAPP group[(1.8 ±1.2)points]was better than (2.9 ± 1.4)points in Lichtenstein group (t=-7.006,P=0.000),the difference was statistically significant.However,the hospitalization cost of TAPP group[(8 842.8 ±415.2)yuan]was higher than (6 676.9 ±327.6)yuan of the Lichtenstein group,the difference was statistically significant(t=6.782,P<0.05).In TAPP group,2 cases had complications after operation,which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months,1 case of recurrence in Lichtenstein group,the recurrence rate was 3.8%.There was no recurrence in the TAPP group.Conclusion TAPP has the advantages of short operation time,less bleeding,rapid postoperative recovery,less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults.

Comparison of the recent curative efficacy of AjustTM sling and TVT in the treatment of stress urinary incontinence / 重庆医学

Objective To evaluate the efficacy and safety of adjustable single-incision sling(AjustTM) and tension-free vaginal tape(TVT) in the treatment of female stress urinary incontinence(SUI).Methods A total of 88 cases with SUI in our department from January 2011 to December 2015 was retrospectively analyzed,including 62 TVT cases and 26 AjustTM cases.The definite diagnose and grading were based on the medical history,physical examination,cystoscopy,uroflowmetry,provocative test and ICI-Q-SF.All cases were followed up on 6 months after surgery and their uroflowmetry,provocative test and ICI-Q-SF were investigated.Results The average operation time of AjustTM group,(10.0 ± 4.2) min,was shorter than that of TVT group,(50.0± 12.6) min (P＜0.01),and the incidence of operative complications in AjustTM group(3.8％) was less than that in TVT group(6.7％),with significant difference(P＜0.05);The application of these two methods in recent cases showed no significantly statistical difference in objective cure rate,subjective satisfaction,intraoperative blood loss,new-onset OAB,dysuria,perineum discomfort and dyspareunia(P＞0.05).Conclusion AjustTM applied in the treatment of SUI has more advantages than TVT over simplicity,efficiency and safety.

Analysis of outcomes of tension-free mid-urethral sling procedure in women with mixed urinary incontinence / 北京大学学报(医学版)

Objective: To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI).Methods: Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up.Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT).Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared.Results: The mean age was 62 years, with a range of 42-80 years.The mean body mass index (BMI) was 26.82 kg/m2, with a range of 21.48-31.14 kg/m2.The mean follow-up time was 26 months, with a range of 8-69 months.Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks.None of the pa-tients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery.After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination.The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured.The patients'' life quality also improved significantly (P<0.05).Conclusion: Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were.And 16 patients didn''t show an overactive bladder, which may due to two reasons.One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra.Proximal urethra is full of nerve, which plays a role in sense and urine control.The sense of urge may come from urethra instead of bladder.Tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence.Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%.The efficacy of surgery remained stable in medium and long term, and the patients'' quality of life improved significantly.

Impact of pelvic muscle training on quality of life in postoperative female patients with stress urinary incontinence / 中国实用护理杂志

Objective To investigate the impact of pelvic muscle training (PFMT) on the quality of life (QOL) and incidence of postoperative complications in stress urinary incontinence (SUI) patients after tension-free vaginal tape surgery (TVT). In order to provide evidence for clinical nurses taking measures to promote rehabilitation of postoperative patients. Methods A total of 101 female SUI patients who underwent TVT surgery were included in this study. 50 patients in the trial group received pelvic muscle training guidance by one-to-one for 3months while 51 patients in the control group were instructed to the routine discharge guidance. All patients were asked to finish the Incontinence-specific Quality of Life questionnaire (I-QOL) at the day before surgery and 3 months after the surgery, respectively. And incidence of postoperative complications were evaluated at 3 months after the surgery. Results A total of 94 participants completed all questionnaires, including 48 patients of the trial group and 46 patients of the control group. The postoperative score of I-QOL in the trial group were higher than that of control group (94.32 vs. 90.34, Z=3.863, P<0.01). Further analysis found that avoidance and limiting behaviors domain score (90.63 vs.87.50, Z=3.227, P<0.01) and psychosocial impacts domain score (97.22 vs. 90.28, Z=4.186, P<0.01) in the trial group were higher than that of control group. The incidence of postoperative urgency urinary incontinence was significantly difference between the two groups (χ2=4.953,P=0.026), the proportion were 16.67% (8/48) in the trial group and 36.96% (17/46) in the control group, respectively. According to the results, the patients′overall quality of life of the trial group was better than that of control group after surgery. Conclusions Postoperative SUI patients′implementation of pelvic muscle training can significantly increase their quality of life and can decrease the incidence of urgency urinary incontinence.