尿路力学的ストレス性尿失禁を有する女性の治療において、自己筋膜直筋膜陰部スリング手術と合成経尿道的膣テープ術の比較研究を行った

A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence.

• J B Sharma
• Manasi Kamalakar Deoghare
• Neerja Bhatla
• Garima Kachhawa
• Reeta Mahey
• Rajesh Kumari
• Amlesh Seth
• Alpana Sharma

抄録

目的:

女性性ストレス性尿失禁（SUI）の治療における自己筋膜直下陰部膣スリング手術と合成経結紮テープ術の短期成績を比較すること STUDY DESIGN：尿力学的に証明されたSUIを有する25～65歳の女性30名を対象に、自己筋膜直下陰部膣スリング手術（I群15名）と合成経結紮テープ術（II群15名）に無作為に割り付けて比較試験を実施した。術前・術後のICIQ（International Consultation on Incontinence Questionnaire）スコア、尿路力学的検査、血清CRPとIL-6を全例に実施した。

OBJECTIVE: To compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) STUDY DESIGN: It was a comparative study on 30 women between 25-65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases.

結果:

年齢、体格指数（BMI）、パリティ、平均ICIQスコア、平均術前CRPおよびIL-6レベルのベースライン特性は2群で同様であった。平均手術時間はI群がII群よりも有意に長かった（55.60±5.77分 vs 25.27±4.32分、p = 0.001）。平均在院日数7.1±1.2日対1.2±0.4日、平均カテーテル留置期間5.8日対1.2日（<0.01）、再カテーテル留置を必要とする術後尿閉はいずれもI群がII群よりも有意に高かった。創部感染症はI群の方がII群よりも多かった(p=0.01)が、鼠径部痛はII群で有意に多かった(p=0.01)。術後のPdet at Q max（尿流ピーク時のデトルーザー圧）は両群ともに有意に上昇した。ICIQスコアは両群とも0であり、100%の成功を示した。外科的外傷はI群の方が多く、CRP値が有意に高いことが示された。

RESULTS: The baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels.

結論:

2つのグループの成功率は似ていたが、自己直腸筋膜スリング手術は経結膜術の膣テープ手術と比較して、時間がかかり、より多くの合併症と尿閉を持っていた。

CONCLUSION: The success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.

Copyright © 2020. Published by Elsevier B.V.