Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Helth Questionnaire before and after surgery. Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

研究目的：评估采用改良直视穿刺针技术的腱膜吊带（aponeurotic sling）术在压力性尿失禁（stress urinary incontinence）患者中的应用价值。
研究方法：本研究于尿流动力学检查（Urodynamic Study, UDS）前约7天，采用国王健康问卷（Kings Health Questionnaire, KHQ）评估患者生活质量，同时完成妇科检查、尿常规分析及尿培养；对接受经耻骨后路径、直视下穿刺针操作腱膜吊带术的患者，术前及术后均行1小时尿垫试验（PAD test），并完成术前与术后的KHQ问卷评估。
研究结果：受试者平均年龄为50.6岁，体质量指数（Body Mass Index, BMI）为28，漏尿压（Leak Pressure, LP）为58.5cm H₂O；89%的受试者为白种人。其中46例患者接受了3个月及6个月随访，43例完成12个月随访。术后12个月的客观治愈率约为93.5%。生活质量评估显示，术后12个月较术前存在显著改善。本研究未出现尿道或膀胱损伤相关并发症。不良事件方面，1例患者出现持续性尿潴留（占比2.3%），该患者接受尿道松解术后目前无尿失禁症状。
研究结论：本研究所采用的术式在膀胱或尿道损伤风险层面安全性良好，可显著改善患者生活质量并实现理想的客观治愈效果。