Clinical Effects, Imaging Study And Treatment Of TOT Procedure Combined With Modified Pelvic Floor Reconstruction On Female Stress Urinary Incontinence

ObjectiveTo assess the safety and efficacy of the transobturator tape (TOT) procdure combined with modified pelvic floor reconstruction for surgical treatment of female stress urinary incontinence and pelvic organ prolapse. Through the static and dynamic MRI examination to understand the alteration of pelvic floor anatomy pre and post-operation of patients and provide image data to support modified pelvic floor reconstruction surgery.MethodsRetrospectively analyzed from January 2008 to July 2010 and 38 women with stress urinary incontinence concomitant pelvic organ prolapses underwent the TOT procedure and modified pelvic reconstruction.38 patients aged 56.84±10.31 years, the disease course was 7.31±8.7 years and the follow-up time is 18.3±6.21 months. With the patient consent to collect the basic information, including name, age, date of surgery, and home address, telephone number, etc, as well as 10 nulliparous control women, who were not pelvic floor dysfunction and non pelvic surgery history. The operations were according to the symptom of different patients,28 modify pelvic reconstruction,8 combined with vaginal body repair,2 combined with hysterectomy. Measuring the urethrovesical angle, the lengths of H-line and M-line, the levator angle per and post-operation, Therapeutic effects were assessed by Grouts-Blaivas and POP-Q outcome score.The results of operations and complications were observed.Results36 cases were epidural anesthesia and 2 cases were general anesthesia. The operation time was 81.89±24.30 minutes, blood loss was 56.63±13.22 ml. Early complications included femoral puncture site pain in 5 cases, dysuria in 3 cases and 2 cases of urinary posture change. There was no long-term complication. POP-Q and Grouts-Blaivas score to evaluate the efficacy and symptoms disappeared completely in 36 cases,2 cases of occasional leakage urine in the intense active, the symptom is significant improvement than the preoperative. Long-term cure rate is 94.74%, the overall rate of satisfaction is 100%, without failing case. Comparing with the preoperative patients, the urethrovesical angle, the B-PCL length, the levator angle, the dynamic widths of levator hiatus in the postoperative group were smaller than the preoperative patients (P<0.05), the average value of the lengths of H-line and M-line and the levator hiatus size were smaller than preoperative patients, but there are no significant difference (P>0.05).ConclusionModified pelvic reconstructive surgery to restore and maintain the normal position of pelvic organs and functions, the tape can instead of the levator ani to resistance the abdominal pressure. It is a new surgical treatment of pelvic floor prolapse associated with stress urinary incontinence. The procedure is simple, less complications and more affordable. The short-time effect is well, however, the long-time affect need more cases of observation.