压力性尿失禁TOT治疗.ppt

* KEY POINT: UI prevalence steadily increases with age. ADDITIONAL INFORMATION: These prevalence estimates based on the Epidemiology of Incontinence in the County of Nord-Trondelag (EPINCONT) Norweigan survey of 28,000 women ages 20 and over show Increasing prevalence during young adult life (prevalence 20-30%) A broad peak around middle age (prevalence 30-40%) A steady increase in the elderly (prevalence 30-50%) Among these women, 50% reported SUI, 11% reported UUI, and 36% reported MUI.1 In addition, Maral et al2 found that the prevalence of SUI increases with age. Therefore, women spend a larger fraction of their lives experiencing stress incontinence than any other type. REFERENCES: 1. Hannestad YS, et al. J Clin Epidemiol. 2000;53(11):1150-1157. 2. Maral I, et al. J Urol. 2001;165(2):408-412. * KEY POINT: These are the predominant risk factors associated with SUI. ADDITIONAL INFORMATION: Vaginal childbirth incites SUI in women. Obesity promotes SUI in women. (Obesity is defined as a body mass index [BMI] ?30. Being overweight is defined as a BMI of 25-29.9.) * (经闭孔穿透的理由) 1. Potential benefits of avoiding retropubic space(耻骨后方) may include * Minimizing risk of bladder perforation, especially in patients who have had prior surgery * Minimizing of retropubic hematoma * Avoidance of bowel * Reduction in major vascular injury 2. Potential benefits of the sling orientation (I.e., hammock shape)(水平位置) may include * Lower incidence of retention and/or de novo urgency Pubic Bone Obturator vessels Iliac vessels Needle trajectory Surgical Concepts 3,5 cm Bladder perforation after TOT(膀胱穿孔) Hermieu et al, 2003 – 1 case baldder perforation Delorme, 2003 – 2 cases bladder perforation Costa et al, 2004 – 1 case bladder perforation 2 cases urethral perforation ? Cystoscopy is not necessary ? Newer Mid-urethral sling OP“TOT”=Trans Obturator Tape=Tension-free Obturator Tape=