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

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。

Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials

Objective　To evaluate the effectiveness and safety of tension-free vaginal tapes (TVT) compared with Burch colposuspension for female stress urinary incontinence (SUI). Methods　We searched MEDLINE (1966 to October 2007), EMBASE (1988 to October 2007), Cochrane Central Register of Controlled Trials (1993 to October 2007), CMCC (1979 to October 2007) and CNKI (January 1979 to October 2007). We collected randomized controlled trials (RCTs) comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2 was used for data analyses. Results　Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Burch colposuspension as measured by the overall cure rate (OR 1.73; 95%CI 1.26 to 2.38; P=0.0007), negative stress test (OR 2.54; 95%CI 1.71 to 3.78; Plt;0.00001) and negative pad test (OR 1.67; 95%CI 1.16 to 2.41; P=0.006). The total complication rate was higher after TVT (OR 1.39; 95% CI 1.08 to 1.80; P=0.01), while the re-operation rate was significantly higher after Burch colposuspension (OR 0.29; 95%CI 0.10 to 0.80; P=0.02). The incidences of haematoma (OR 1.06; 95% CI 0.39 to 2.84; P=0.91), urinary tract infection (OR 1.27; 95% CI 0.64 to 2.52; P=0.50) and lower urinary tract symptoms (OR 1.20; 95% CI 0.89 to 1.62; P=0.23) were similar after TVT and Burch colposuspension. Conclusion　The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.

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.

EXPERIMENTAL STUDY ON COMBINING SELECTIVE RHIZOTOMY OF DIFFERENT ANTIERIOR AND POSTERIOR SACRAL ROOTS FOR RESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY

OBJECTIVE: To investigate an alternative procedure for complete denervation of bladder in the supra-cone cord injury to restore the bladder function. METHODS: Sixteen dogs were included in this study after their spinal cords were transected above the cone. They were divided into 6 groups and performed the rhizotomy of L7 to S3 root in different combination respectively. The bladder and urethra pressure change by electrostimulation during operation and cystometrogram change after operation were tested. RESULTS: 1. Electrostimulation study: for bladder innervation, S2was the most important and S1 was secondary. While for urethra innervation, S1 was more important than S2. When the anterior and posterior roots of S1 and S2 were intact with rhizotomy of posterior roots of L7 and S3, stimulated the common or posterior root of S1 and S2, the change of pressure in bladder and urethra was the same. When the anterior roots of S1 and S2 were resected with rhizotomy of posterior roots of L7 and S3, the pressure in bladder and urethra was significant decreased compared to stimulating the corresponding posterior roots. 2. Cystometrogram (CMG) study: in the complete deafferented group, resecting the posterior roots of L7 to S3, the bladder became flaccid. While resecting the posterior root of S2 and anterior root of S1 or, resecting the posterior root of S1 and anterior root of S2, combining with rhizotomy of posterior roots of L7 and S3, the CMG curve was similar to the complete deafferented group. In the S1 and S2 intact group, the bladder became spastic. CONCLUSION: Combining rhizotomy of anterior and posterior sacral root in different level has the same effects on bladder as complete deafferentation.

Risk factors for urinary incontinence following acute stroke: a Meta-analysis

Objective To study the risk factors of urinary incontinence in acute stroke patients and provide scientific evidence for preventing and managing such complication. Methods A computerized literature search was performed on both English and Chinese databases including Embase, Medline, Wanfang Data, VIP, and CNKI from January 1990 to January 2017 based on such search strategies as literature review and manual retrieval. In addition, we tracked down the related reference lists. The RevMan 5.3 software was used for Meta-analysis. Categorical data were calculated by the pooled odds ratio (OR) values and 95% confidence intervals (CI), and numerical data were calculated by pooled mean difference (MD) and 95%CI. Results A total of 17 articles of controlled studies with 2 428 cases and 3 725 controls were included. According to the results of Meta-analysis, factors associated with urinary incontinence following acute stroke were age [MD=2.80, 95%CI (0.29, 5.30),P=0.03], female gender [OR=1.29, 95%CI (1.16, 1.45),P<0.000 01], diabetes [OR=1.40, 95%CI (1.13, 1.73),P=0.002], heart disease [OR=1.65, 95%CI (1.29, 2.13),P<0.000 1), former cerebrovascular disease [OR=1.43, 95%CI (1.21, 1.69),P<0.000 1), speech disorder [OR=4.20, 95%CI (3.45, 5.10),P<0.000 01], smoking [OR=0.68, 95%CI (0.50, 0.92),P=0.01]. Hypertension [OR=1.25, 95%CI (0.99, 1.58),P=0.06], left hemisphere involvement [OR=1.29, 95%CI (0.81, 2.06),P=0.29], and hemorrhagic stroke [OR=1.26, 95%CI (0.79, 2.03),P=0.33] were not correlated with urinary incontinence following acute stroke. Conclusions Older age, female gender, diabetes, heart disease, former cerebrovascular disease and speech disorder are risk factors associated with post-stroke urinary incontinence, while smoking lowers the potential risk. However, hypertension, hemorrhagic stroke and left hemisphere involvement do not significantly increase the risk of urinary incontinence following stroke.

The Clinical Utilization of Laparoscopic Burch Operation in Treatment of 32 Stress Urinary Incontinence Cases QI

目的:探討腹腔鏡下膀胱頸Cooper韌帶懸吊術(Burch手術)治療女性壓力性尿失禁的使用方法和臨床價值。方法: 回顧性總結2005年3月至2009年2月采用腹腔鏡Burch手術治療女性壓力性尿失禁的臨床資料32例。結果:手術時間75～140 min,平均90 min,術中出血40～80mL,平均55mL。隨訪3～12個月,平均6個月,32例患者中28例癥狀完全緩解,4例有效。無1例手術并發癥。結論: 采用腹腔鏡Burch手術治療壓力性尿失禁臨床效果滿意,并發癥少,是一種較為理想的方法。

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.

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.

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。