A Comparative Study On The Clinical Efficacy Of Simple Transobturator Midurethal Sling And Pelvic Floor Reconstruction In The Treatment Of POP Secondary Stress Urinary Incontinence

Objective: The purpose of this study was to compare the complications,success rate and satisfaction of pelvic floor reconstruction after obturator tension-free sling(TOT)and Pelvic floor reconstruction after TOT merger in the treatment of female stress urinary incontinence.To explore the pathogenesis of stress urinary incontinence after pelvic floor stress injury and improve the surgical treatment strategy.Methods: From August 15,2018 to February 24,2022,patients diagnosed with stress urinary incontinence(SUI)and secondary prolapse of the anterior pelvis were selected to receive TOT or Pelvic floor reconstruction after TOT merger.Participants were followed up and evaluated at 2 months,6 months and 1 year after treatment.According to the patient’s chief complaint,the patient can urinate automatically without incontinence;The number of urinary incontinence and urine leakage were significantly reduced compared with those before operation;Urinary incontinence symptoms did not improve or worsen as ineffective,observe the efficacy and complications.Results:We included 191 patients in the TOT group and 151 patients in the pelvic floor reconstruction group after TOT.The hospital stay in the TOT group was(3.06 ±0.74)days,and that in the pelvic floor reconstruction group after TOT was(3.93 ±1.05)days.However,the TOT group needed a second operation to treat recurrent SUI(2.09%),and the reoperation rate in the combined pelvic floor repair group was(1.99%).In TOT group,one patient(0.52%,1/191)suffered from puncture injury to the bladder,and two patients(1.05%,2/191)suffered from intraoperative injury to the lateral wall of the vagina.There was no surgical side injury in TOT combined with posterior pelvic floor reconstruction.Most of the perioperative complications were dysuria(6.28 in TOT group).The number of postoperative dysuria in the group with posterior pelvic floor reconstruction was 1.99%.The cure rate of TOT group was(86.39%,165/191),and the effective rate was(90.58%,173/191).The cure rate of combined pelvic floor reconstruction group was(90.73%,137/151),and the effective rate was(94.79%,143/151).Compared with the combined pelvic floor reconstruction group,the surgical effect was significant.In addition,we put forward the concept of complete success rate,which means that there is no complication during operation,effective after operation,and no reoperation.Compared with the complete success rate of 153/191(80.10%)in the simple TOT group and 139/151(92.05%)in the pelvic floor reconstruction treatment group after TOT,the difference between the two groups was significant and statistically significant.It can better reflect stress urinary incontinence combined with POP II degree,and posterior pelvic floor repair is the best choice.The complete success rate and effective rate were significantly higher than those of TOT group,and the patient satisfaction and complete success rate were high.Conclusion:TOT combined with posterior pelvic floor reconstruction has a definite short-term effect on patients with stress urinary incontinence and anterior pelvic secondary prolapse.The operation design should pay attention to the support of the posterior wall of the perineum to the bladder neck and the middle and proximal end of the urethra.