The Clinical Effect Analysis Of Two Types Sling Surgery In The Treatment Of Female Stress Urinary Incontinence

Stress urinary incontinence(SUI)is coughing,laughing,sneezing ect abdominal pressure increases suddenly,without bladder detrusor contractions,urine is not controled overflow from the urethra.Foreign literatures review the incidence of adult female urinary incontinence is about 33%,50% of urinary incontinence is SUI,and increasing with age,Chinese adult female SUI prevalence rate is as high as 18.9%,at 50 to 59 years old age,the incidence is the highest,at 28.0%,SUI incidence increased with age.For the treatment of SUI,American Urological Association(AUA)Through a comprehensive literature retrieval and rigorous analysis suggests that surgery for most SUI patients had long-term(more than 48 months),definite curative effect.Lucas put forward SUI surgical treatment guidelines in 2013,make the tension-free vaginal tape as grade A recommended.There are three kinds of the operation,The second generation trans-obturator tension-free vaginal tape(TVT-O)become the classic,The cure rate is as high as 90.8% for five years.adjustable singleincision sling(A-JUST)as the third generation of operation method,different countries were followed up for 6 ~ 12 months the cure rate was 80%~91%.Foreign research reports,A-JUST surgery compared with the classical TVT-O surgery,no difference between the subjective and objective curative rate,have exact effect.A-JUST surgery first applied in China in 2012,less domestic research on the contrast of two kinds of surgical curative effect.This study reviews the analysis of two kinds of operation method of clinical therapeutic effect,for SUI patients selection individual treatment plan provide clinical reference.ObjectiveTo compare the clinical efficacy of A-JUST surgery and TVT-O surgery in the treatment of female SUI,for SUI patient selection individual treatment plan provide clinical reference.Materials and methodsSelect the patients who during Jan.2013 to Dec.2014 see a doctor in The Third Affiliated Hospital of Zhenzhou University,diagnosed with SUI and undergo surgery by the same doctor.A total of 105 cases of eligible patients,53 cases in group A-JUST,TVT-O group are 52 cases.Record two groups of patients age,course of the disease,gravidity and parity history,body mass index(BMI),an hour urine pad test weight,combination with other operation etc preoperative general data;Statistics the perioperative data include operation time,intraoperative blood loss,postoperative groin pain,postoperative urethral urine tube time,hospitalization days.Two groups of patients in preoperative and postoperative 6,12,24 months follow-up,fill in the Incontinence Quality of life Questionnaires(I-QOL)and Patient Global Impression of Improvement(PGI-I),check the postoperative urination,urine leakage and 24 months of postoperative complications.The above information for statistical analysis,P<0.05 for the difference was statistically significant.Result1.There were no significant differences in preoperative general data(P>0.05)between the two groups.The two groups are comparable.2.No significant difference in operation time,intraoperative blood loss and postoperative urethral urine tube time was shown between these two groups(P>0.05).1 case have postoperative pain with inner thighs at day after surgery in group A-JUST;8 cases have postoperative pain with inner thighs at two days after surgery in group TVT-O.Rate of pain with inner thighs of two groups are 1.9% and 13.4%,P=0.010,the difference was statistically significant.The average hospitalization days,group A-JUST and group TVT-O are 3.58±1.44 d and 7.47±1.83 d,p=0.000,the difference was statistically significant.3.preoperative and postoperative 3,6,12,24 months follow-up I-QOL score,A-JUST group are 25.27±4.43、90.43±4.42、90.48±4.39、87.15±5.52,TVT-O group are22.17±3.72、90.28±6.76、90.63±6.05、86.63±5.65,It is proved that both A-JUST and TVT-O group had significant improvement in I-QOL(P<0.05),but no significant difference was found in the average improvement in I-QOL between these two groups(P>0.05).Two groups of patients with preoperative quality of life affected by the disease at the same degree,the quality of life improved obviously after surgical treatment.4.Postoperative follow-up 6 months of urine leakage,evaluation objective cure rate.A-JUST group was 88.7%,TVT-O group was 88.5%,P=0.932;PGI-I score evaluation Subjective cure rate,A-JUST group was 88.7%,TVT-O group was 92.3%,P=0.884.these two groups in cure rate did not reach statistical significance.Both types of operation are effective treatment of SUI.5.After 24 months of follow-up,three cases in A-JUST group appear leakage of urine when abdominal pressure increases,one case in A-JUST group appear foreign body sensation when sexual intercourse.The incidence of complications was 7.5%(4/53).In TVT-O group,two cases appear Leakage of urine when abdominal pressure increases,one case appear sling exposure,the incidence of complications was 5.8%(3/52).Between the two groups,no significant differences in complications(χ~2=0.117,P >0.05).ConclusionA-JUST operation treatment of female SUI,short-term follow-up curative effect is obvious,there are no difference about Subjective and objective cure rate,Compared with TVT-O operation.Both A-JUST operation and TVT-O operation are effective and reliable in treatment of female SUI.A-JUST procedure has advantages in lower rate of groin pain and hospitalization days.