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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 阮雍順 | 利用無張力陰道吊帶治療應力性尿失禁合併神經性膀胱婦女的長期效 | 2010/5/30 下午 05:13:07 | 0 |
| 原 文 | 題 目 | Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders |
| 作 者 | Abdul-Rahman A, Attar KH, Hamid R, Shah PJ. | |
| 出 處 | BJU International | |
| 出版日期 | 2009 November; Paper in press | |
| 評 論 |
目前對於治療應力性尿失禁的患者，已經有相當好的治療方法與治療的效果(包括尿道懸吊手術以及藥物治療)，但是對於應力性尿失禁的患者合併有神經性膀胱(不管是逼尿肌無力或者是膀胱感覺異常)，如何給予適當的治療來改善患者應力性尿失禁的狀況，仍然是一個令醫師與患者困擾的課題。 本文作者Ahmad收集了12位脊椎損傷同時合併有應力性尿失禁以及解尿困難狀況的患者，Ahmad醫師為他們施以尿道懸吊手術以治療應力性尿失禁，手術之後再以尿失禁影響問卷調查、膀胱尿路動力學以及生活品質問卷等方式評估術後的改善程度。經過十年的追蹤發現在術前需要以導尿管單導解尿的還是維持一樣的解尿方式，而術前可以自解尿液的也並不會增加解尿的困難度，而且這12位患者中有11位都可以成功的解決應力性尿失禁的困擾，而另一位則對於每天只使用1-2片護墊的生活品質也十分滿意。 經由本研究的發現，應力性尿失禁合併有神經性膀胱(不管是逼尿肌無力、逼尿肌過動或者是膀胱感覺異常)並不是尿道懸吊手術的禁忌症，無張力的尿道懸吊手術可以改善病人膀胱儲尿時的應力性尿失禁，而不會明顯影響解尿時的尿道阻力。這篇文章也提供了我們以後治療患者時的重要參考。 |
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| abstract |
OBJECTIVE： To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS： Twelve women (mean age 53.3 years, range 41-80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patients notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS： The mean (range) follow-up was 10 (8.5-12) years. Nine patients were using clean intermittent self-catheterization before the ion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS： In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, ion of TVT should be considered a desirable treatment, with very good long-term outcomes. |
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