Clinical Analysis Of 37 Cases Of Female Stress Urinary Incontinence Treated With TVT-O

Background: Tension-free middle urethral suspension(TVT-O)via obturator is one of the most effective and popular surgical methods for the treatment of female stress urinary incontinence(SUI).However,because the high incidence of postoperative complications affects the subjective feelings of patients after operation,many patients question the safety and efficacy of this operation in the treatment of stress urinary incontinence.Objective: To analyze the subjective efficacy of TVT-O in the treatment of female SUI,the improvement of quality of life and quality of sexual life,as well as the occurrence and management of postoperative complications,and then to evaluate the clinical efficacy of TVT-O in the treatment of female stress urinary incontinence.Methods: The clinical data of 37 female patients who were hospitalized for SUI and received TVT-O in Dalian Maternal and Child Care Service Centre from September2014 to December 2019 were analyzed retrospectively.The subjective curative effect,the occurrence and management of postoperative complications,the quality of life and sexual life before operation,3 months,6 months and 12 months after operation were followed up.The incontinence impact questionnaire short form(IIQ-7)was used to evaluate the quality of life.Single factor repeated measurement analysis of variance was used to evaluate the improvement of quality of life of SUI patients before and after operation.Single factor analysis of variance was used to compare the improvement of postoperative quality of life of SUI patients with different severity.The pelvic organ prolapsed-urinary incontinence sexual questionnaire-12(PISQ-12)was used to evaluate the sexual life quality,and the single factor repeated measurement analysis of variance was used to evaluate the improvement of sexual life quality before and after operation.Results: Curative effect evaluation: 12 months after operation,the subjective cure rate of 37 patients was 81.1%(30/37),the improvement rate was 13.5%(5/37),and the ineffective rate was 5.4%(2/37).The subjective cure rate of 5 patients with mild SUI was100%(5/5).The subjective cure rate of 14 patients with moderate SUI was78.6%(11/14),the improvement rate was 14.3%(2/14),and the ineffective rate was7.1%(1/14).The subjective cure rate of 18 patients with severe SUI was 77.8%(14/18),the improvement rate was 16.7%(3/18),and the ineffective rate was 5.5%(1/18).Evaluation of quality of life: the IIQ-7 scores at 3 months,6 months and 12 months after operation were significantly lower than those before operation,and the quality of life at each time point selected after operation was significantly better than that before operation,and the difference was statistically significant(P<0.001,P<0.001,P<0.001).The IIQ-7 scores of each time point selected after operation were compared in pairs.The IIQ-7 score at 6 months after operation was slightly higher than that at 3 months after operation,but the difference was not statistically significant.The score at 12 months after operation was higher than that at 3 months and 6 months after operation,and the quality of life was slightly lower than that at 3 months and 6 months after operation,and the difference was statistically significant(P=0.019,P=0.016).The results of mild,moderate and severe SUI groups showed that the IIQ-7 scores at 3 months,6months and 12 months after operation were significantly lower than those before operation,and the quality of life at each time point after operation was significantly better than that before operation(P<0.001,P<0.001,P<0.001).With the extension of time,the IIQ-7 score in each group increased gradually,but the difference was not statistically significant.There was no significant difference in IIQ-7 score between mild,moderate and severe SUI patients at 3 months,6 months and 12 months after operation.Evaluation of the quality of sexual life: 16 of the 37 patients had sex before and after operation.The PISQ-12 scores of these patients before,3 months,6 months and 12 months after operation,respectively,were 26.44±4.41,28.38±4.60,28.19±4.64,27.50±5.01.Compared with those before operation,the PISQ-12 score increased at 3months and 6 months after operation,and the quality of sexual life was significantly improved compared with that before operation,and the difference was statistically significant(P=0.013,P=0.028).The PISQ-12 score at 12 months after operation was also higher than that before operation,but the difference was not statistically significant.The pairwise comparison of PISQ-12 score at each time point after operation showed that the PISQ-12 score and the quality of sexual life at 12 months after operation were lower than those at 3 months and 6 months after operation,and the difference was statistically significant(P=0.011,P=0.029).The PISQ-12 score at 6 months after operation was lower than that at 3 months after operation,but the difference was not statistically significant.Postoperative complications: during the follow-up period,24patients(64.9%)had at least one postoperative complication,of which 12 patients(32.4%)had inguinal pain,10 patients(27.0%)had dysuria(2 patients had postoperative urinary retention),and 2 patients(5.4%)had new postoperative OAB.One patient(2.7%)developed sling exposure 12 months after operation.Conclusion: The subjective cure rate and improvement rate of female SUI treated with TVT-O are high.TVT-O can improve the quality of life of SUI patients with different severity,as well as the quality of sexual life of patients.The incidence of complications after TVT-O is high,but serious complications are not common.TVT-O is an effective and safe method for the treatment of female SUI.