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Australian Safety and Efficacy Register of New Interventional Procedures-Surgical-Annual Report 2001(Ⅰ)

TREATMENT OF FEMALE STRESS URINARY INCONTINENCE WITH TENSION-FREE VAGINAL TAPE

Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.

Expert consensus on multimodal assessment system for pelvic floor function

Female pelvic floor dysfunction (PFD) is a common disease affecting women's quality of life, especially in older women. The establishment and application of multimodal evaluation system is the key to the accurate diagnosis and effective treatment of PFD. The purpose of this expert consensus is to provide a comprehensive, multi-layered assessment framework that includes clinical examinations, imaging examinations, biomechanical tests, and questionnaires to comprehensively assess pelvic floor function in women. By integrating different assessment methods, we aim to improve the early identification and diagnostic accuracy of PFD, so that personalized treatment can be developed to improve patient outcomes. The consensus also discusses the advantages and disadvantages of various assessment techniques and suggests directions for future research and clinical applications.

Feasibility and safety of tension-free vaginal tape-obturator for female stress urinary incontinence under the daytime surgical mode based on the concept of enhanced recovery after surgery

Objective To explore the feasibility and safety of tension-free vaginal tape-obturator for female stress urinary incontinence under the daytime surgical mode based on the concept of enhanced recovery after surgery. Methods The clinical data of female patients with stress urinary incontinence at the First Affiliated Hospital of Kunming Medical University between June 2019 and June 2023 were retrospectively analyzed. According to the perioperative management mode of patients, they were divided into daytime surgery group and routine surgery group. The basic, intraoperative, and postoperative conditions of two groups of patients were compared. Results Finally, 183 patients were included, including 91 in the routine surgery group and 92 in the daytime surgery group. All patients successfully completed the surgery. There was no statistically significant difference in age, preoperative comorbidities, surgeon in chief, or operation duration between the two groups of patients (P>0.05). The preoperative waiting time after hospitalization [(0.00±0.00) vs. (2.42±0.58) d], hospitalization expenses [(13815.10±2906.01) vs. (18095.21±3586.67) yuan], total surgical expenses [(3961.36±707.35) vs. (4440.19±1016.31) yuan], anesthesia expenses [(718.53±61.06) vs. (755.30±74.65) yuan], western medicine expenses [(818.07±259.30) vs. (1282.14±460.75) yuan], total hospitalization duration [(1.11±0.31) vs. (5.77±1.30) d], and postoperative hospitalization duration [(1.11±0.31) vs. (3.35±1.42) d] in the daytime surgery group were lower than those in the routine surgery group (P<0.05). There was no significant difference between the two groups in postoperative complications (respiratory complications, fever, nausea and vomiting, vaginal bleeding, urinary retention, peritonitis), satisfaction, postoperative pain or self perception of symptom improvement (P>0.05). Conclusion The daytime surgery for female stress urinary incontinence based on the concept of enhanced recovery after surgery is safe and feasible, which can shorten hospitalization duration and reduce hospitalization costs.

托吡酯治療導致成人癲癇患者尿失禁二例

恥骨后無張力陰道吊帶術治療女性壓力性尿失禁

目的 探討恥骨后無張力陰道吊帶術（tension-free vaginal tape technique，TVT）治療女性壓力性尿失禁（stress urinary incontinence，SUI）的臨床療效。 方法 回顧分析2004 年1 月－ 2010 年1 月57 例采用TVT 治療的女性SUI 患者臨床資料。患者年齡36 ～ 64 歲，平均54 歲；病程1 年6 個月～ 13 年。均有1 ～ 3 次生育史。誘發試驗及膀胱頸抬舉試驗均呈陽性。14 例合并陰道前壁脫垂。5 例有逼尿肌不穩定表現。漏尿點壓測定為3.93 ～ 10.98 kPa。 結果 4 例術中發生穿破膀胱，重新調整方向后完成手術。3 例拔除尿管后出現排尿困難，經對癥處理后恢復正常排尿。術后12 個月采用Grouts-Blaivas 評分法評價療效，治愈48 例（84.2%），改善良好8 例（14.0%），改善中等1 例（1.8%）。尿流動力學檢查示，術后3、12 個月尿流率較術前顯著下降，最大尿道閉合壓顯著升高（P lt; 0.05）。根據尿失禁生活質量量表（I-QOL）評價，術后3 個月患者在日常活動、心理障礙及社會尷尬方面的主要評分指標較術前有顯著性提高（P lt; 0.05）；術后12 個月患者各項指標均較術前改善（P lt; 0.05）。 結論 TVT 手術操作簡便、安全有效，能顯著提高患者生活質量，是治療女性SUI 的有效手段。

Quality appraisal of evidence-based guidelines for the management of female stress urinary incontinence

ObjectivesTo evaluate the quality of evidence-based guidelines for the treatment of female stress urinary incontinence, so as to provide evidence for clinical stress urinary incontinence management research.MethodsWebsite of the professional society, clinical practice guide website, Yimaitong website, PubMed, CNKI, WanFang Data and VIP databases were electronically searched to collect stress urinary incontinence management related guidelines from January 1st, 2014 to January 1st, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included guidelines using Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the characteristics of each guidelines were analyzed.ResultsWe identified totally 8 relevant evidence-based guidelines in this field. The average standardized scores in the 6 domains of AGREE II were 90.74% (scope and purpose), 78.71% (stakeholder involvement), 74.60% (rigor of development), 93.52% (clarity of presentations), 61.81% (applicability), and 91.67% (independence). The overall standardized scores of 8 guidelines were 77.70%, and the total scores were 5.31 (out of 7). For overall quality, 4 of them were grade A and 4 of them were grade B.ConclusionsThe overall quality of evidence-based guidelines for stress urinary incontinence is high, and scores in different fields are vary large. Fields of " stakeholder involvement”, " rigor of development” and " applicability” with lower scores still requires strengthening. The current guidelines for female stress urinary incontinence in China still fails to meet the standards of evidence-based guidelines, so the quality of the guidelines should be improved to improve guide clinical practice.

Clinical Comparison between Tension-Free Vaginal Tape and Tension-Free Vaginal Tape-obturator for Female Stress Urinary Incontinence

ObjectiveTo compare the clinical outcome of tension-free vaginal tape (TVT) and TVT-obturator (TVT-O) for female stress urinary incontinence (SUI). MethodsSixty-one female SUI patients were included in our study, in which 33 received TVT procedure and 28 received TVT-O procedure. The patients were followed up for 1 to 62 months post-operatively, averaging at 22 months. Cure was defined as no leakage during the stress test and no residual urine showed by B ultrasound, improvement as less leakage during the stress test after operation, and inefficacy as leakage during the stress test and no difference was detected after operation. ResultsAge and disease course were not significantly different between the two groups (P>0.05). All patients underwent TVT or TVT-O procedure successfully. Time of TVT ranged from 26 to 45 min averaging at (35.5±4.3) minutes, and it was significantly different from the time of TVT-O which ranged from 15 to 20 min averaging at (7.2±3.1) minutes (P<0.05). Bleeding during the surgery was not significantly different between the two groups (P>0.05). The rate of complications occurring during TVT-O procedure was significantly less and milder than that during the TVT procedure (P<0.05). The cure rate and improvement rate indicated no significant differences between the two groups (P>0.05). ConclusionThe evidence available indicates that TVT and TVT-O procedure are both effective and safe for female SUI. Compared with TVT, TVT-O procedure has the advantages of being more convenient, shorter operation time, being less invasive, and fewer complications, and it may be more suitable for female SUI.

The Investigation of the Appliances for Urinary Incontinence in Elderly Male Patients

目的:了解成都市住院老年男性尿失禁患者尿失禁處理用物的使用及并發癥發生情況。方法:用自行設計的量表對188位尿失禁老人的一般情況、尿失禁的分級及處理用物等進行調查。結果:隨著尿失禁的嚴重程度的增加,患者或其家人選擇的處理用物增加。男性尿失禁的不同處理用物被選用的多少依次為:尿布(585%)、尿壺(340%)、一次性尿墊(255%)、保鮮袋(186%)、避孕套式尿袋(69%)、留置導尿(37%)及假性尿器(27%),不同尿失禁分級的患者對處理用物的選擇差異有統計學意義(Plt;005);2周患者399%發生漏尿,133%局部皮膚發紅,27%皮膚糜爛及21%尿路感染。結論:臨床工作中應該根據尿失禁的不同分級及患者的綜合情況指導患者及其照顧者選擇合適的處理用物,目前老年男性尿失禁患者仍然欠缺舒適、經濟、實用的接尿設備。

Prevalence of urinary incontinence in Chinese adult women: a meta-analysis

ObjectivesTo provide reference for decision-making on prevention and treatment of urinary incontinence by assessing the prevalence of urinary incontinence in Chinese adult women. MethodsWe searched CNKI, VIP, WanFang Data, CBM, PubMed, EMbase, The Cochrane Library to collect cross-sectional studies on urinary incontinence in adult women in mainland China from inception to June 2018. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata 12.0 software. ResultsA total of 20 studies were involved, including 90 126 patients. Meta-analysis showed that the prevalence of urinary incontinence in adult women was 31.1% (95%CI: 28.3% to 34.0%). The subgroup analysis showed that stress urinary incontinence was the main subtype, of which was mainly with mild incontinence, with an average prevalence rate of 27.5% (95%CI: 22.6% to 32.4%) in urban areas and 32.5% (95%CI: 23.3% to 41.7%) in rural areas; 30.9% (95%CI: 26.8% to 35.1%) in the south and 31.4% (95%CI: 26.0% to 36.7%) in the north. The prevalence rate was rising from 2005 to 2008, and it remained at a high level in the following years, and the prevalence increased with age. ConclusionsThe prevalence of urinary incontinence in adult women in China has been at a high level since 2005. There has been no significant improvement in the past 10 years. Therefore, we should attach great importance to it and take appropriate interventions to prevent the occurrence of urinary incontinence.