| Purpose:We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of stress urinary incontinence in women at 1-year at most followup. The indicators include objective and subjective effects, side effects and risk factors of the cure rate.Materials and Methods:In this prospective analysis, women with urinary incontinence treated by surgery carried out in the department of urology in our hospital from August 2014 to November 2015 were included. The patients were divided by TVT-O:TVT-A=1:2. There were 7 cases of TVT-O and 17 cases of TVT-A, and the whole number was 24. Objective evaluation consists the operation duration, blood loss, postoperative catheterisation and post-operation hospital stays, and we recorded ICIQ-SF, KHQ, PGI-I and patient satisfaction (defined as a 10-point visual analog scale) as subjective data. The ICIQ-SF and KHQ questionnaires were recorded before the surgery. The patients were followed up after the treatments in 1.5,3,6,9 and 12 months. They were asked to fill in the ICIQ-SF, KHQ, PGI-I and patient satisfaction in telephone. We analyzed the factors that might be related with the subjective cure rate (ICIQ-SF/PGI-I/patient satisfaction). Analysis was performed using SPSS version 19.0 with significance levels set at P= 0.05.Results:Seven cases of TVT-O and 16 cases of TVT-A were successfully followed up. No patients went through a retreatment due to recurrence. In TVT-O group, patients felt less pain than the other group (P=0.036). The subjective satisfaction rates were different among different questionnaires. According to the KHQ,5 women in TVT-O group(71.4%) and 14 women in TVT-A group(87.5%) had a clinically significant improvement 18 points or more in total KHQ compared to baseline)(P=0.557). The patients reported success rates were 6/7(85.7%) and 13/16(81.3%) by ICIQ-SF with no significant differences between the groups(P= 1.000). As for the PGI-I, the results were 7/7(100.0%) in TVT-O and 16/16(100.0%) in TVT-A(P= 1.000). Patients in TVT-O group were totally satisfied (100.0%) while in TVT-A group the proportion is (87.5%)(P=1.000). Operation duration, blood loss, postoperative catheterisation and post-operation hospital stays all made no differences between the two groups. As for the influence factors, age, parity, BMI, disease duration and parameters of urodynamics didn’t affect the postoperative ICIQ-SF. Postoperative follow-up duration had a negative correlation with ICIQ-SF (P=0.001). Pre-operation ICIQ-SF had a negative correlation with PGI-I(P=0.014) and satisfaction(P=0.048). Both two kinds of operations worked out to have same effects on type Ⅰ/Ⅱ/Ⅲ stress urinary incontinence(P=1.000).Conclusions:1. The patient reported success rate and improvement in KHQ had no significant differences between the groups while each of the surgery work out to be a good choice;2. The surgical procedure has nothing to do with operation duration, blood loss, post-operation hospital stays and postoperative catheterisation;3. Patients in TVT-A group may suffer less pain than in TVT-O group;4. The subjective cure rate would not be influenced by age, parity, BMI, disease duration and preoperational parameters of urodynamics. Moreover, the short-term effects of transobturator tension-free vaginal tape in type Ⅰ/Ⅲ/Ⅲ SUI make no difference between the two groups.5. The cure rate may get better with time goes on. According to a discussion only on aspect of statistics,16 months after the sugery is the time when the cure rate reach the optimum. A pre-surgery evaluation may hint the prognosis of the patient. That is to say, more serious the symptom is, the higher satisfaction the patients get. |
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