Analysis Of The Efficacy Of Tension-Free Vaginal Tape Obturator

ObjectiveTo investigate the long term efficacy of Tension-free vaginal tape obturator(TVT-O)on female stress urinary incontinence and dry overactive bladder and the improvement of patients' quality of life after surgery,to analysis on risk factors affecting the long term efficacy of stress urinary incontinence and dry bladder overactivity,and to study the changes of other lower urinary tract symptoms after surgery.Materials and methods1 Study objectFrom January 2007 to December 2014,a total of 589 patients underwent TVT-O surgery in our pelvic floor reconstruction department,including 116 patients who met our inclusion and exclusion criteria.Inclusion criteria:patients have stress urinary incontinence(SUI)combined with dry overactive bladder,and do TVT-O surgery in our hospital due to stress urinary incontinence.Exclusion criteria:a history of urgent urinary incontinence within one week before admission;pelvic organ prolapse;bladder outlet obstruction;neurogenic bladder;urinary calculi;preoperative ultrasound measurement of postvoid residual volume?150ml;acute urogenital infection period;malignant tumors;patients with severe medical or surgical diseases who are not suitable for surgery.Followed up for 5 years after operation,95 cases were followed up completely,and the follow-up rate was 81.9%.The average parity of 95 patients was 2.18±1.16,average body mass index(BMI)24.43±2.10kg/m2,average abdominal leak point pressure(ALPP)83.89±19.07cmH2O,The results of urodynamic examination showed that 41 cases of stress urinary incontinence complicated with detrusor overactivity.2 Postoperative follow-up and observed indicatorsThe way of postoperative follow-up was outpatient follow-up,the follow-up time was 6 months and 1 year after operation,and then once a year until 5 years after operation.In this paper,the short-term effect refers to the curative effect of 6 months after operation,the medium and long-term effect is 1?3 years after operation,and the long-term effect refers to the curative effect of 3 years after operation.Follow-up content:(1)Inquire the patient's postoperative symptoms of lower urinary tract in detail(including storage symptoms,voiding symptoms and post-micturition symptoms);(2)Gynecological examination was performed in outpatient clinic and postoperative pelvic floor organ prolapse and sling exposure were recorded;(3)The patients underwent 1 hour pad test and filled out the Overactive bladder symptom score(OABSS)and Incontinence impact questionnaire short form(IIQ-7).Curative effect evaluation index:(1)The curative effect evaluation index of stress urinary incontinence included subjective symptom and 1 hour urine pad test.Evaluation cure:no urine leakage in the case of increased abdominal pressure such as coughing,running and jumping,and negative urine pad test in 1 hour;improvement:symptoms of urine leakage in the case of increased abdominal pressure such as coughing,running and jumping,and urine leakage in 1 hour urine pad test decreased by?50%compared with that before treatment;ineffective:there was urine leakage in the case of increased abdominal pressure such as coughing,running,jumping,and the amount of urine leakage in 1 hour urine pad test was less than 50%less than that before treatment.The improvement of the quality of life of postoperative patients was evaluated by IIQ-7.(2)The therapeutic effect of dry overactive bladder is evaluated by OABSS.cure:preoperative diagnosis of dry overactive bladder,postoperative symptom scores did not reach the diagnosis of dry overactive bladder;improvement:the OABSS score after operation was lower than that before operation;no change:there was no change in OABSS score before and after operation;aggravated:the OABSS score after operation was higher than that before operation.3 Statistical analysisSPSS 21.0 software was used for statistical analysis.Counting data was expressed using composition ratio and measurement data was expressed.The comparison of count data uses chi-square test or Fisher's exact probability method,and the rank data uses rank sum test.The statistically significant factors in the single factor analysis were further analyzed by binary logistic regression analysis,and the significance level was ?=0.05.Result1.The short-term cure rate of female stress urinary incontinence after TVT-O is 75.8%,and the cure rate of 3 and 5 years after operation is 73.7%.The effect of the operation is stable,the IIQ-7 score is lower than that before operation,and the quality of life of patients is better than that before operation.Parity,ALPP and the shortest time of delivery interval were related to the long-term efficacy of SUI after TVT-O(P<0.05).Parity and ALPP were independent risk factors affecting the long-term efficacy of SUI.2.The short-term cure rate of dry overactive bladder after TVT-O was 54.7%,which decreased to 37.9%3 years after operation and 33.7%5 years after operation,the cure rate showed an overall downward trend.the cure rate of 5 years after operation was statistically significant compared with 6 months after operation,and the postoperative OABSS score was lower than that before operation.The preoperative urodynamic results and age were related to the long-term effect of dry overactive bladder after TVT-O(P<0.05),and were independent risk factors affecting the long-term effect of dry overactive bladder.3.In the changes of other lower urinary tract symptoms caused by TVT-O surgery,the incidence of dysuria(0.0%vs 2.1%),post micturition dribble(0.0%vs 5.3%),postural voiding(0.0%vs 2.1%))were higher than those before operation,but there was no statistical significance;The incidence of postoperative urination interruption(2.1%vs 9.5%),prolonged micturition time(1.1%vs 12.6%),incomplete bladder emptying(2.1%vs 12.7%)was significantly higher than that before,and the difference was statistically significant.Conclusion1.The short-term effect of TVT-O in the treatment of stress urinary incontinence is significant,the long-term effect is stable,and the quality of life of patients after surgery is improved.Parity and ALPP are independent risk factors that affect the long-term efficacy of stress urinary incontinence.2.TVT-O has a certain improvement effect on dry overactive bladder,but the long-term efficacy is reduced.Age and preoperative urodynamic results are independent risk factors that affect the long-term efficacy of dry overactive bladder.3.TVT-O can effectively improve the symptoms of storage lower urinary tract symptoms(stress urinary incontinence and dry overactive bladder),on the other hand,it can increase the incident rate of postoperative voiding lower urinary tract symptoms(interruption of urination,prolonged micturition time,dysuria and posture urination)and post-micturition lower urinary tract symptoms(post micturition dribble,incomplete bladder emptying).