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CELLULAR THERAPY OF STRESS URINARY INCONTINENCE

【Abstract】 Objective To review the progress and cl inical appl ication of cellular therapy for stress urinaryincontinence (SUI). Methods The l iterature about cellular therapy of SUI was extensively reviewed. Results Becauseof having no or poor regeneration capacity, the cl inical application of chondrocytes and myoblasts were l imited. Based on the rapid progress in stem cell biology, an increasing number of animal experiments and cl inical trials about cellular therapy of SUI have been reported with encouraging results. All these show that cellular therapy has great potential in cl inical application. Stem cells are considered as ideal seeded-cells for treatment of SUI. Conclusion Cellular therapy, especially stem cells, provides a novel approach for treatment of SUI, but the mechanism needs further study.

耻骨后无张力阴道吊带术治疗女性压力性尿失禁

目的 探讨耻骨后无张力阴道吊带术（tension-free vaginal tape technique，TVT）治疗女性压力性尿失禁（stress urinary incontinence，SUI）的临床疗效。 方法 回顾分析2004 年1 月－ 2010 年1 月57 例采用TVT 治疗的女性SUI 患者临床资料。患者年龄36 ～ 64 岁，平均54 岁；病程1 年6 个月～ 13 年。均有1 ～ 3 次生育史。诱发试验及膀胱颈抬举试验均呈阳性。14 例合并阴道前壁脱垂。5 例有逼尿肌不稳定表现。漏尿点压测定为3.93 ～ 10.98 kPa。 结果 4 例术中发生穿破膀胱，重新调整方向后完成手术。3 例拔除尿管后出现排尿困难，经对症处理后恢复正常排尿。术后12 个月采用Grouts-Blaivas 评分法评价疗效，治愈48 例（84.2%），改善良好8 例（14.0%），改善中等1 例（1.8%）。尿流动力学检查示，术后3、12 个月尿流率较术前显著下降，最大尿道闭合压显著升高（P lt; 0.05）。根据尿失禁生活质量量表（I-QOL）评价，术后3 个月患者在日常活动、心理障碍及社会尴尬方面的主要评分指标较术前有显著性提高（P lt; 0.05）；术后12 个月患者各项指标均较术前改善（P lt; 0.05）。 结论 TVT 手术操作简便、安全有效，能显著提高患者生活质量，是治疗女性SUI 的有效手段。

TREATMENT OF FEMALE STRESS URINARY INCONTINENCE WITH TENSION-FREE VAGINAL TAPE

Objective To investigate the indication, approaches andpreventionof complications in treatment of female stress urinary incontinence(SUI) with tension-free vaginal tape (TVT). Methods From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3years. The disease course was 1.42 years(7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. Results All patients achieved satisfactory results.The complications included slight dysuria(2 cases),vesical perforation(1 case) and pelvic hematoma(1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. Conclusion TVT is effective for SUI.

EXPERIMENTAL STUDY ON COMBINING SELECTIVE RHIZOTOMY OF DIFFERENT ANTIERIOR AND POSTERIOR SACRAL ROOTS FOR RESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY

OBJECTIVE: To investigate an alternative procedure for complete denervation of bladder in the supra-cone cord injury to restore the bladder function. METHODS: Sixteen dogs were included in this study after their spinal cords were transected above the cone. They were divided into 6 groups and performed the rhizotomy of L7 to S3 root in different combination respectively. The bladder and urethra pressure change by electrostimulation during operation and cystometrogram change after operation were tested. RESULTS: 1. Electrostimulation study: for bladder innervation, S2was the most important and S1 was secondary. While for urethra innervation, S1 was more important than S2. When the anterior and posterior roots of S1 and S2 were intact with rhizotomy of posterior roots of L7 and S3, stimulated the common or posterior root of S1 and S2, the change of pressure in bladder and urethra was the same. When the anterior roots of S1 and S2 were resected with rhizotomy of posterior roots of L7 and S3, the pressure in bladder and urethra was significant decreased compared to stimulating the corresponding posterior roots. 2. Cystometrogram (CMG) study: in the complete deafferented group, resecting the posterior roots of L7 to S3, the bladder became flaccid. While resecting the posterior root of S2 and anterior root of S1 or, resecting the posterior root of S1 and anterior root of S2, combining with rhizotomy of posterior roots of L7 and S3, the CMG curve was similar to the complete deafferented group. In the S1 and S2 intact group, the bladder became spastic. CONCLUSION: Combining rhizotomy of anterior and posterior sacral root in different level has the same effects on bladder as complete deafferentation.

Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials

Objective　To evaluate the effectiveness and safety of tension-free vaginal tapes (TVT) compared with Burch colposuspension for female stress urinary incontinence (SUI). Methods　We searched MEDLINE (1966 to October 2007), EMBASE (1988 to October 2007), Cochrane Central Register of Controlled Trials (1993 to October 2007), CMCC (1979 to October 2007) and CNKI (January 1979 to October 2007). We collected randomized controlled trials (RCTs) comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2 was used for data analyses. Results　Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Burch colposuspension as measured by the overall cure rate (OR 1.73; 95%CI 1.26 to 2.38; P=0.0007), negative stress test (OR 2.54; 95%CI 1.71 to 3.78; Plt;0.00001) and negative pad test (OR 1.67; 95%CI 1.16 to 2.41; P=0.006). The total complication rate was higher after TVT (OR 1.39; 95% CI 1.08 to 1.80; P=0.01), while the re-operation rate was significantly higher after Burch colposuspension (OR 0.29; 95%CI 0.10 to 0.80; P=0.02). The incidences of haematoma (OR 1.06; 95% CI 0.39 to 2.84; P=0.91), urinary tract infection (OR 1.27; 95% CI 0.64 to 2.52; P=0.50) and lower urinary tract symptoms (OR 1.20; 95% CI 0.89 to 1.62; P=0.23) were similar after TVT and Burch colposuspension. Conclusion　The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.

Australian Safety and Efficacy Register of New Interventional Procedures-Surgical-Annual Report 2001(Ⅰ)

The Investigation of the Appliances for Urinary Incontinence in Elderly Male Patients

目的:了解成都市住院老年男性尿失禁患者尿失禁处理用物的使用及并发症发生情况。方法:用自行设计的量表对188位尿失禁老人的一般情况、尿失禁的分级及处理用物等进行调查。结果:随着尿失禁的严重程度的增加,患者或其家人选择的处理用物增加。男性尿失禁的不同处理用物被选用的多少依次为:尿布(585%)、尿壶(340%)、一次性尿垫(255%)、保鲜袋(186%)、避孕套式尿袋(69%)、留置导尿(37%)及假性尿器(27%),不同尿失禁分级的患者对处理用物的选择差异有统计学意义(Plt;005);2周患者399%发生漏尿,133%局部皮肤发红,27%皮肤糜烂及21%尿路感染。结论:临床工作中应该根据尿失禁的不同分级及患者的综合情况指导患者及其照顾者选择合适的处理用物,目前老年男性尿失禁患者仍然欠缺舒适、经济、实用的接尿设备。

The Clinical Utilization of Laparoscopic Burch Operation in Treatment of 32 Stress Urinary Incontinence Cases QI

目的:探讨腹腔镜下膀胱颈Cooper韧带悬吊术(Burch手术)治疗女性压力性尿失禁的使用方法和临床价值。方法: 回顾性总结2005年3月至2009年2月采用腹腔镜Burch手术治疗女性压力性尿失禁的临床资料32例。结果:手术时间75～140 min,平均90 min,术中出血40～80mL,平均55mL。随访3～12个月,平均6个月,32例患者中28例症状完全缓解,4例有效。无1例手术并发症。结论: 采用腹腔镜Burch手术治疗压力性尿失禁临床效果满意,并发症少,是一种较为理想的方法。

经耻骨上膀胱尿道悬吊术治疗女性压力性尿失禁围手术期的护理

摘要:目的: 探讨经耻骨上膀胱尿道悬吊术（SPARC）围手术期的护理。方法: 我科室于2007年1月至2008年6月采用SPARC治疗6例临床诊断为女性压力性尿失禁的病人，进行围手术期护理。结果: 住院3～7天，平均5天。6例病人术后尿控满意，随访3月，1例有轻度尿失禁，余无排尿困难、尿失禁及尿路感染。结论: SPARC治疗女性压力性尿失禁具有简单、安全、创伤小、疗效好的特点，再配合积极的护理，有效的膀胱功能锻炼，是提高术后效果，促进排尿自控的重要措施，值得临床推广。

AdVance吊带系统治疗前列腺电切术后压力性尿失禁的手术配合

目的探讨AdVance吊带系统治疗前列腺电切术后压力性尿失禁（PPI）的手术配合及护理要点，以提高男性压力性尿失禁手术治疗的效果。 方法2010年3月和10月2例PPI患者采用AdVance吊带系统进行手术治疗，术前做好心理护理及术野皮肤护理，准备手术器械和特殊用物，术中与术者积极配合，遵医嘱预防性使用抗生素，正确合理安置手术体位，注意保暖，使手术过程顺利、流畅，缩短手术时间。 结果2例患者手术顺利，术后均无伤口感染发生。术后分别随访12、18个月，漏尿症状基本缓解。 结论在采用AdVance吊带系统治疗男性PPI时，充分的术前准备及积极、准确的术中配合，可达到提高手术效率，缩短手术时间和降低并发症发生率的目的。