Анатомічні та функціональні результати двох варіантів слінгових оперативних втручань для хірургічної корекції стресового нетримання сечі в жінок

Abstract

The problem of urinary incontinence is one of the leading causes of deterioration of the quality of life of women of various age categories. Modern and effective surgical treatment of this pathology is sling surgery. Therefore, the search for the optimal variant of such an operation remains an actual direction in modern gynecology. Aim - to compare the immediate and long-term results of two variants of sling operations for stress urinary incontinence. Materials and methods. A comparative study of immediate and long-term outcomes after sling surgery for surgical correction of stress incontinence was conducted in 84 women who were divided into two groups. In the 1st group, plastic surgery with a free synthetic loop (TVT) was performed, in the 2nd group - an operation using a transobturator arrangement of a prolene loop (TVT-Obturator - TVT-О). All patients were comprehensively examined using clinical, instrumental and laboratory research methods. Statistical data processing was carried out using the SPSS 21 program. Results. The analysis of sonographic indicators of the state of the urethrovesical segment in women of both groups established a significant decrease in the angle of inclination and the posterior urethrovesical angle. There were no significant differences in these parameters between the I and II groups, which proves the comparable effectiveness of TVT and TVT-O regarding the correction of the anatomical defect. Instead, it was established that the TVT technique allows to achieve a higher frequency of cases of complete urinary continence 2 years after the operation - 87.9% versus 67.9% in the TVT-O group, as well as a lower number of urges and episodes of urge incontinence after 1 year (p=0.047 and p=0.03, respectively) and 2 years (p=0.012 and p=0.02, respectively) after sling installation. Conclusions. The obtained data indicate the anatomical efficiency of both options of sling installation, however, the efficiency of the TVT operation, according to the evaluation of the functional results of the surgical intervention, is statistically significantly higher than the TVT-O operation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.