Single branch mesh urethral suspension combined with vaginoplasty in the treatment of stress urinary incontinence in women with degree Ⅰ-Ⅱ anterior pelvic prolapse
Objectives To investigate the results of single-branch mesh urethral suspension combined with vaginoplasty in the treatment of female patients with stress urinary incontinence combined with degree Ⅰ-Ⅱ anterior pelvic prolapse.Methods Data of 80 female patients with SUI combined with degreeⅠ-Ⅱ anterior pelvic prolapse admitted to the First Affiliated Hospital of Kunming Medical University from April to November 2021 were retrospectively analyzed.Patients'age were(53.6±11.7)years old.The number of pregnancies were(3.1±1.4).Five cases had a history of hysterectomy.All patients had SUI symptoms,positive pressure evoked test and positive finger pressure test.Ultrasonography suggested increased bladder neck mobility,mild bladder bulging image,and widening of the area of the fissure of the anal muscle.According to the simplified pelvic organ prolapse staging system,there were 7 cases combined with degree Ⅰ anterior pelvic prolapse and 73 cases with degree Ⅱ anterior pelvic prolapse.All 80 cases in our group underwent single branch mesh suspension combined with vaginoplasty under general anesthesia.The patients underwent the truncated position.The pelvic floor repair mesh was cut as a prototype of single-branch mesh,consisting of the left and right arms and the main part in the middle,which was inverted"T"-shaped with symmetrical left and right arm.Compared with the traditional sling and mesh,the left and right arms of the single mesh were widened to ensure that the arms had a larger force surface in the pubic descending branch to prevent the sling from moving.The middle body part was widened so that the force surface was continued from the mid-urethra to the bladder neck.A puncture of 0.5 cm lateral to the lower edge of the bilateral pubic descending branch was selected to guide the double arms of the single mesh to penetrate from the inside to the outside to complete the suspension of the single mesh.Vaginoplasty was used to repair the torn anorectalis muscle,shape the perineal body,reconstruct the external anal sphincter in layers,and narrow the vagina to a"double trumpet"shape.Follow-up were conducted once at 1,3 and 6 months after the operation,and the PGI-Ⅰ was used to evaluate the effect of anterior pelvic prolapse repair.In the absence of other postoperative treatments,the complete disappearance of SUI symptoms and the ability to control the urination on their own were regarded as cure of SUI;the reduction of SUI symptoms compared with the preoperative period,the small amount of urinary leakage during vigorous activities,and the absence of urinary leakage in daily activities were regarded as improved;no improvement or further aggravation of SUI symptoms compared with the preoperative period,and still unable to control urine leakage was considered as ineffective.Results Eighty cases of surgery were successfully completed.Surgical time was(90±8)min,and intraoperative bleeding was(20±10)ml.Eighty cases were able to urinate on their own after removing the urinary catheter at 48 h postoperatively,the residual urine volume measured by ultrasonography was＜50 ml,and hospital stay were 72 h postoperatively.The results of subjective cure of anterior pelvic prolapse evaluated by the PGI-Ⅰ questionnaire in 80 cases showed that 76 cases(95.0％)were subjectively cured,and 4 cases(5.0％)were subjectively relieved.For SUI,78 out of 80 cases were cured(97.5％)and 2 cases were improved(2.5％).None of the patients developed urinary retention,urinary tract infection,abnormal bladder contractility,or bladder outlet obstruction.Conclusions Single-branch mesh suspension ensures tension-free suspension of the entire urethra and is effective in treating stress urinary incontinence combined with anterior pelvic prolapse of degree Ⅰ-Ⅱ,with good short-term results.
万方数据
维普
