The Role Of Free Uroflowmetry In Evaluating The Efficacy Of TVT-O In The Treatment Of Female Stress Urinary Incontinence

Objective:1.To assess the efficacy and safety of retropubic tension-free vaginal tape-obturator(TVT-O)after implantation for the treatment of female stress urinary incontinence(SUI).2.To discuss on the role of free uroflowmetry in evaluating the efficacy of TVT-O in the treatment of female stress urinary incontinence.3.To discuss on the role of free uroflowmetry and international consultation on incontinence questionnaire short form(ICI-Q-SF)and incontinence quality of life measure(I-QOL)in female SUI treatment and curative effect evaluation.Methods:Between March 2010 and January 2018,a total number of 34 female patients with SUI who underwent TVT-O procedure in the second hospital of Hebei medical university were included.Among the 34 patients,20 patients were conducted pure TVT-O operation,it was also associated with pelvic organ prolapse treatment in 10 patients;4 patients with uterine fibroids were performed laparoscopic myomectomy or hysterectomy.The data had been collected and analyzed retrospectively.A detailed record of age,medical history,reproductive history,complications,preoperative ICI-Q-SF and I-QOL score,maximum urinary flow rate,average urinary flow rate,time to maximum urinary flow rate,void volume,operation method,operation time,postoperative complications,days of postoperative urinary drainage tube stet,the hospitalization time after operation,the postoperative ICI-Q-SF and I-QOL score,the follow up information and other items.Efficacy evaluation criteria: evaluation of curative effect can be divided into subjective evaluation and objective evaluation.Standard of objective evaluation,Cure: no leakage during cough,sneeze and other stress test;Improvement: the woman had less leakage during the stress test postoperation;inefficacy: leakage during the stress test.Objective evaluation: negative Marshall-bonney test.SPSS Statistics Programme 21.0 was used for the analysis.Compare the maximum urine flow rate,ICI-Q-SF and I-QOL score before and after the surgery.Statistical significance was set at P < 0.05.Result:The mean operation time was(29.57±5.96)min in pure TVT-O patients;the days of postoperative urinary drainage tube stet was 1~7d,and the hospitalization time after operation were 3~7d.Complications included 2 groin pain and 2 de novo urge urinary incontinence,which were improved after symptomatic treatment.Postoperative urinary retention was observed in 1 patient,and the symptoms disappeared after prolonged indwelling catheter.There was a sling erosion in vaginal in 2 cases,both of them were postmenopausal patients,and the area was less than 1cm.Among them 1 case occurred in 2 months after the surgery with vaginal discomfort,after using estrogen for two months,nothing improved,so we cut off the exposed part;Another case occurred in 12 months after the operation,showing a small amount of bleeding in vaginal.After the exposed part was cut off,the symptoms disappeared,and both of them did not suffer relapse during the follow-up.Intraoperative injury such as bladder injury,urethra injury,obturator nerve injury,intestinal perforation,hematoma were not found;The overall cure rate was 85.29%(29 of 34 patients)and 8.82%(3 of 34 patients)had improvement of symptoms.The subjective effective rate was 94.12%,and the objective cure rate was 91.18%.The postoperative ICI-Q-SF and I-QOL scores were lagarly better than preoperative ones(P<0.05),well the maximum flow rates,average urinary flow rate,time to maximum urinary flow rate,void volume,were not statistically different(P>0.05).Conclusion:The TVT-O procedure is a safe and efficient treatment for female SUI,with maintenance of high cure rates after a 8-yr maximum follow-up.Meanwhile,free uroflowmetry can choose the patient who can perform this operation and international consultation on incontinence questionnaire short form(ICI-Q-SF)and incontinence quality of life measure(I-QOL)play an important role in female SUI treatment and curative effect evaluation.