The efficacy of autogenous femoral lateral iliotibial fascia in the treatment of female stress incontinence / 中华泌尿外科杂志

ABSTRACT

Objective To analyze the safety and efficacy of autogenous femoral lateral iliotibial fascia(autologous fascia lata) in the treatment of female stress incontinence.Methods The clinical data of 7 female patients with stress incontinence admitted from January 2016 to June 2017 were retrospectively analyzed.The mean age was 58.2 years (range 45-72 years).The mean disease duration was 10.7 years (range 5-21 years).The mean Body mass index (BMI) was 24.1 kg/m2 (range 20.3-31.4 kg/m2).7 patients had severe subjective scores according to clinical symptoms.The average score of urinary incontinence questionnaire-simple form (ICIQ-SF) of international urinary incontinence advisory committee was 14.3 ± 1.1,the score of incontinence-quality of life (I-QOL) was 24.3 ± 4.8,respectively.During general anesthesia,the patient was placed in a half-recumbent position with the right leg straight down and the left leg bent over.The position of patella as well as the iliotibial band of the lateral femoral muscles were marked on the body surface.The iliotibial fascia of the lateral femoral muscle was exposed through a transverse incision 4-6 cm perpendicular to the iliotibial fascia of the lateral femoral muscle.The fascia of the lateral iliac tibial fascia of the lateral vastus with a width of 1.5 to 2.0 cm and a length of 12 to 14 cm was cut.The fascia was immersed in physiological saline and sutured with two 2-0 CT1PDS absorbable sutures or 2-0 vascular sutures at both ends of the fascia for 3 consecutive needles to form a sling.Then the urethral catheter was placed in the position of lithotomy,and then urethral suprapubic suspension was performed using autologous fascia through bilateral paravaginal incisions.The duration of surgery,intraoperative blood loss,intraoperative complications,postoperative catheter indwelling time,the length of hospital stay and postoperative complications were recorded.The situation of urinary incontinence as well as life quality before and after surgery were compared respectively.Results The operation was successfully performed.The mean operative time was 117.6 min(range 95-140 min).The mean intraoperative blood loss was 70.3 ml (range 50-90 ml).No complication was observed during the operation.The mean postoperative indwelling catheterization was 5.8 days (range 5-7 days).The mean postoperative hospital stay was 6.3 days (range 5-8 days).All 7 patients were cured after surgery,2 patients experienced urinary retention after removal of the catheter.The mean follow-up time was 18.2 months(range 13-24 months).No urinary incontinence or complications was observed postoperatively in all cases.Patient ICIQ-SF urinary incontinence questionnaire summary score and quality of life score of I-QOL questionnaire of 1 year post operation were 0.6 ± 0.5 and 96.1 ± 4.3,which were significantly improved compared with that before surgery(P ＜ 0.01).Conclusion It is safe to use autologous femoral lateral muscle iliotibial fascia in the middle segment of urethra suspension for the treatment of female stress incontinence,and the curative effect is affirmative through one-year observation.