The Curative Effect Of The Vaginal Mesh-repair Surgery For Female Stress Urinary Incontinence

Objective1.To evaluate the curative effect of the vaginal synthetic mesh-repair surgery through the way of building a new cave of right and left antetheca-retropublic space for female stress urinary incontinence(SUI).2.To compare and analyze one-year cure rate and complications of the new operation with the Burch retropubic urethropexy and tension-free vaginal tape procedure(TVT?TVT-O).The safety,curative effect and innovation of the new one were investigated as well as the disadvantages.MethodsWe analyzed 256 cases treated with the new surgery from January 2012 to December2014,187 cases of them with the concomitant symptom of anterior vaginal wall prolapse.Using the statistic software SPSS 21.0 Ridit analysis and Chi-square Test was conducted to describe the cure rate of this minimally invasive operation,respectively.And comparative t-test was used to analyze the ICIQ-SF scores before and after surgery.1.Accepting criteria:(1)the one who was treated with conservative treatment but failed or couldn't insist;(2)patients with moderate or severe SUI;(3)patients with POP and SUI who needed surgery.Except other kinds of UI and patients with operative contraindication or the one lost to follow-up.2.Diagnostic criteria:According to one-hour pad test:SUI is divided into four degrees:(1)Mild:pad gain?2g;(2)Moderate:2g<pad gain?10g;(3)Severe:10g<pad gain<50g;(4)Very severe:pad gain?50g.3.Evaluation of curative effect3.1 Subjective criterion:ICIQ-SF score is used to detect changes in quality of life before and after the surgery for SUI.3.2 Objective criterion:Whether dose leakage occur when we increase abdominal pressure,just like coughing?If not,SUI is cured.If pad gain is less than half of the past,the symptom of SUI is relieved.On the contrary,the treatment is ineffective.3.3 Result of AVWP:According to standard POP-Q classification system:Cure:POP-Q<II°;Recur:POP-Q?II°.4.Follow-up:All patients were reviewed once every 3 months within 1 year after the operation and then once 1 year.Results1.The 256 cases with SUI were performed with the vaginal synthetic mesh-repair surgery.According to 1 hour pad-test evaluation,the curative effect rate six month postope-ration was 91.0%(233/256),improvement rate was 9.0%(23/256),inefficiency was 0.And one year later,the rate was 91.8%(235/256),7.0%(18/256),1.2%(3/256),respectively.Therewas no difference in cure rate between postoperative 1 year and 2 year(U=0.75,P=0.45;U=0.57,P=0.57).2.There were 187 patients with the symptom of AVWP and there was a striking effect1 year and 2 year after surgery(U=12.54,P<0.01;U=11.85,P<0.01).No difference was found in cure rates between postoperative 1 year and 2 year(U=1.04,P=0.30).3.The ICIQ-SF scores were significantly lower and the quality of life was greatly improved postoperative 1 year and 2 year than the preoperation(Moderate:t=28.180,P<0.001;t=27.833,P<0.001;Severe:t=27.929,P<0.001;t=26.499,P<0.001).4.Cure rate of the minimally invasive type of vaginal synthetic mesh-repair postoperative 1 year 91.0%(233/256)was close to that of the Burch and TVT-O reported in the literature(?~2=1.708,P=0.191;?~2=0.282,P=0.586).The minimally invasive surgery could obtain good short-term and long-term effect without severe complications such as massive hemorrhage,urinary organs damages,retropubic space bleeding,chronic pain,discomforts during sex and so on.Conclusions1.The vaginal synthetic mesh-repair surgery has good short and long-term effect on SUI and AVWP.Most of patients are greatly satisfied with the curative effect.2.The operation can be done under anesthesia in the out-patient department,which is time-saving.It is more minimally invasive.3.One year after surgery,the curative rate of vaginal synthetic mesh-repair surgery shows no significant difference to the same time rate of Burch retropubic urethropexy and TVT-O.Without severe complications,it meets the expectations of being secure,effective,economical,which deserves to be promoted widely.