بررسی نتایج عمل تعلیق گردن مثانه با فاسیا در بیماران مبتلا به بی اختیاری استرسی ادرار

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامائی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 ارولوژیست، بیمارستان مهدیه، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دستیار زنان و مامائی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

4 پزشک عمومی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: بی اختیاری ادراری از علائم بسیار شایعی است که بر کیفیت زندگی میلیونها نفر در جهان تاثیری نامطلوب دارد. تعلیق
گردن مثانه با نواری ازفاسیا (PFS) به عنوان یک روش جراحی موثر در درمان بی اختیاری استرسی ادرار بکار می رود. هدف از
این مطالعه بررسی و تعیین میزان بهبودی کامل ، بهبود نسبی و شکست عمل جراحی تعلیق گردن مثانه با نواری از فاسیا در بیماران
طی 3 سال می باشد.
روش کار: در این مطالعه مقطعی- توصیفی تحلیلی پرونده 30 بیمار مبتلا به بی اختیاری استرسی ادراری که تحت عمل تعلیق
گردن مثانه با نواری از فاسیا قرار گرفتند، نتایج عمل جراحی بررسی و اطلاعات بدست آمده توسط نرم افزار SPSS نسخه 11
مورد تجزیه وتحلیل قرار گرفت.
نتایج : متوسط سن بیماران 43/9 ± 8/4 سال بود که 53/3% آنان مبتلا به بی اختیاری مختلط ادراری و 46/7% آنان مبتلا به بی
اختیاری استرسی خالص ادراری بودند. مدت زمان پیگیری22/3 ±9 /4 ماه بود. 73/3% بهبودی کامل یافته، 13/3% بهبودی نسبی
داشته و در 13/3% عمل با شکست مواجه شد. میزان بهبودی کامل در بی اختیاری استرسی خالص ادراری 100% بود در حالیکه در
نوع بی اختیاری مختلط ادراری 50% بود (P=0/008). همچنین میزان بهبودی کامل با مدت زمان وجود علائم، تعداد زایمان طبیعی،
ترکیب اعمال جراحی انجام شده و سن ارتباط معنی دار نداشت (P>0/05)، اما اختلالات لگنی همراه (سیستوسل و رکتوسل) با
میزان بهبودی کامل ارتباط معنی داری داشت (P=0/04).از بیماران 3ا/83% بارضایت کامل، 6/7% رضایت نسبی و 10% عدم رضایت
داشتند. عوارض کوتاه مدت در 33/3% و عوارض دراز مدت در 26/7% دیده شد. شایعترین عارضه زود هنگام، خونریزی واژینال و
شایعترین عارضه تاخیری عود علائم بود.
نتیجه گیری : تعلیق گردن مثانه با نواری از فاسیا روش موثر با حداقل عوارض و نتایج پایدار در بیماران مبتلا به بی اختیاری
استرسی ادراری به ویژه درنوع بی اختیاری استرسی خالص ادراری می باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The evaluation of Pubovaginal Fascial Sling in Stress Urinary Incontinence in 30 Patients

نویسندگان [English]

  • Nahid Mostaghel 1
  • Soheyla Peyro 2
  • Shadi Mohammadi 3
  • Azar Zamani 4
1 Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Urologist, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Resident of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 MD., Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Urinary incontinence is a very common symptom that adversely affects the quality of life of millions of people over worldwide. Pubovaginal fascial sling (P.F.S) is one of the effective surgical methods in treatment of urinary stress incontinence. The aim of this study was to determine the cure rate, improvement and failure rate in patients who underwent P.F.S. within 3 years.
 
Methods: In a descriptive-analytic study 30 patients with urinary stress incontinence who had P.F.S. surgery were studied. Results of all surgeries data were analyzed with SPSS Version 11.
 
Results: The Mean age was 43.9±8.4 years. Patients who sufferings from mixed urinary incontinence were 53.3% and the 46.7% had pure urinary stress incontinence. The mean follow up period was 22.3±9.4 months and 73.3 % were cured. Improvement was seen in 13.3% and in 13.3% surgery had failed. Cure rate in pure urinary stress incontinence was 100% and in mixed urinary incontinence was 50% (P=0.008). In addition, there was no significant difference between cure rate and duration of symptoms, vaginal delivery number, combination of operations, and age (P>0.05) but pelvic disorders (cystocele, rectocele) had significant correlation with cure rate (P=0.04). In our patients 83.3% were satisfied while 6.7% were partially satisfied and 10% were unsatisfied. Early complications were seen in 33.3% and late complications were seen in 26.7%. Vaginal bleeding was the most common early complication and the recurrence of urinary incontinence was the most common late complication.
 
Conclusion: Pubovaginal fascial slingis an effective and safe method with long standing results in urinary stress incontinence especially in pure stress urinary incontinence.

کلیدواژه‌ها [English]

  • Urinary Incontinence
  • Stress Urinary Incontinence
  • Pubovaginal Sling
  • Urge Incontinence
  • Mixed Urinary Incontinence
1. Blavis JG, Groutz A. Urinary incontinence: pathophysiology, evaluation and management
overview. In: Walsh PC, Retik AB, Vaughan ED. Campbell's urology. 8th
ed.
Philadelphia:Saunders; 2002:P.1027-52.
2. Wall LL. Urinary stress incontinence. In: Rock JA, Jones Hw. Telinde's operative gynecology.
9
th ed. Philadelphia:Williams & Wilkins;2003:P.1033-80.
3. Stothers L, Raz S. The reliability, validity and gendur differences in quality of life score for
urinary incontinence. Am Urolo Assoc Meeting, orlando, Florida. 1996 May 4-9. Abstracs.
4. Diokno AC. Epidemiology and psychosocial aspects of incontinence. Urol Clin North Am
1995 Aug;22(3):481-5.
5. McGuire EJ, Clemens JQ. Pubovaginal slings. In: Walsh PC, Retik AB, Vaughan ED.
Compbell's urology. 8th ed. Philadelphia: Saunders;2002:P.1151-71.
6. Kuo HC. Long-term results of surgical treatment for female stress urinary incontinence. Urol Int
2001;66(1):13-7.
7. Kaplan SA, Te AE, Young GP, Andrade A, Cabelin MA, Ikeguchi EF. Prospective analysis of
373 consecutive women with stress urinary incontinence treated with a vaginal wall sling: the
Columbia–Cornell University experience. J Urol 2000 Nov;164(5):1623-7.
8. Morgan TO Jr, Westney OL, McGurie EJ. Pubovaginal sling: 4-YEAR outcome analysis and
quality of life assessment. J Urol 2000 Jun;163(6):1845-8.
9. Petrou SP, Frank I. Complications and initial continence rates after a repeat pubovaginal sling
procedure for recurrent stress urinary incontinence. J Urol 2001 Jun;165( 6 Pt 1):1979-81.
10. Chan PT, Fournier C, Corcos J. Short–term complications of pubovaginal sling procedure for
genuine stress incontinence in women. Urology 2000 Feb;55(2):207-11.
11. Kochakarn W, Leenanupunth C, Ratana-olarn K, Roongreungslip U, Siripornpinyo N.
Pubovaginal sling for the treatment of female stress urinary incontinence: experieare of 100
cases at Ramathibodi Hospital. J Med Assoc Thai 2001 Oct;84(10):1412-5.
1. 12 .Scarpero HM, Nitti VW. Management of urinary retention and obstruction following
surgery for stress urinary incontinence. Curr Urol Rep 2002;3(5):354-9 .
12. Carr LK, Walsh PJ, Abraham VE, Webster GD. Favorable outcome of Pubovaginal sling for
geriatric women with stress incontinence. J Urol 1997 Jan;157(1):125-8 .
13. Silva-Filho AL, Triginell SA, Noviello MB, Santos–Filho AS, Pires CR, Cunha-Melo JE.
Pubovaginal sling in the treatment of stress urinary incontinence for urethral hypermobility and
intrinsic sphincteric deficiency. Int Braz J Urol 2003 Nov-Dec;29(6):540-4.
14. Reichelt O, Weirich T, Wundelich M, Schubert J. Pubovaginal cutaneous fascial sling
procedure for stress urinary incontinence: 10 year experience. Urol Int 2004;72(4): 318-23.
15. Clyne OJ, O'sullivan O, Flood HD. Pubovaginal sling for urodynamic stress incontinence: effect
on patient quality of life. Ir Med J 2005 Mar; 98(3):75-7.
16. Richter HE, Varner RE, Sonders E, Hodley RL , Norithen A, Cilver SP. Effects of pubovaginal
sling procedure on patients with urethral hypermobility and intrinsic sphincteric deficiency:
would they do it again?. Am J Obstet Gynecol 2001 Jan;184(2):14-9.
17. Chou EC, Flisser AJ, Panagopoulos G, Blavias JG. Effective treatment for mixed urinary
incontinence with a pubovaginal sling. J Urol 2003 Aug;170(2 Pt 1):494-7.
18. Cross CA, Cospedes RD, McGuire EJ. Our experience with pubovaginal sling in patients with
stress urinary incontinence. J Urol 1998;159(4):1195-8.
19. Kwon E, Schulz JA, Flood CG. Success of pubovaginal sling in paitents with stress urinary
incontinence and efficacy of vaginal sling release in patients with post–sling voiding
dysfunction. J Obstet Gynaecol Can 2006 Jun;28(6): 519-25. 
 
20. Mitsui T, Tanaka M, Moriya K, Kakizaki H, Nonomura K. Clinical and urodynamic outcomes
of pubvaginal sling procedure with autologous rectus fascia for stress urinary incontinence. Int
J Urol 2007 Dec;14(12):1076-9.
21. Zaragoza MR. Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress
incontinence. J Urol 1996 Nov;156(5):1620-2.
22. Tuab DA, Hollenbeck BK, Wei JT, Dunn RL, McGuire EJ , Latini JM. Complications
following surgical intervention for stress urinary incontinence: a national perspective. Neurourol
Urodyn 2005;24(7): 659-65.
23. Novara G, Galfano A, Boscolo–Berto R, Secco S, Cavalleri S, Ficarra V, et al . Complication
rates of tension–free midurethral slings in the treatment of female stress urinary incutinence: a
systematic review and meta–ananlysis of randomized controlled trials comparing tension–free
midurethral tapes to other surgical procedures and different devices. Eur Urol 2008
Feb;53(2):288-308.
24. Bai SW, Sohn Wh, Chung DJ, Park JH, Kim SK. Comparsion of the efficacy of burch
colposuspension, pubovaginal sling, and tention–free vaginal tape for stress urinary
incontinence. Int J Gynecol Obstet 2005 Dec;91(3): 246-51.
25. Albo ME, Richter HE , Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch
colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007
May 24;356(21):2143-55.
26. Novara G, Ficarra V, Boscolo–Berto R, Seccos , Cavalleri S , Artibani W. Tension–free midurethral
slings in treatment of female stress urinary incontinence: a systematic review and meta-analysis of
randomized controlled trials of effectiveness. Eur Urol 2007 Sep;52(3):663-78.
27. Sharifiaghdas F, Mortazavi N. Tension-free vaginal tape and autologous rectus fascia
pubovaginal sling for the treatment of urinary stress incontinence: a medium-term follow-up.
Med Princ Pract 2008;17(3):209-14.
28. Zeller FL, Miani F, Pavese L, Sotelano J, Alvarez M. The treatment of female stress urinary
incontinence (SUI) using fascia lata in a rural hospital Arch Esp Urol 2008 Jun;61(5):597-602.
29. Morgan DM, Dunn RL, Fenner DE, Faerber G, DeLancey JO, McGuire EJ, et al. Comparative
analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal
sling and tension-free vaginal tape. J Urol 2007 Feb;177(2):604-8.