2005-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/644680在1995年首先由Ulmsten教授發展出使用無緊張性陰道束帶 (tension-free vaginal tapeTVT)手術來治療婦女尿失禁（stress urinary incontinence, SUI) |[-3】。直至目前，以手術方法治療SUI已超過150種 之多【4】但這幾年來由於TVT手術方法容易操作，非常高的成功率以及非常 低的手術所引起的併發症，因此TVT手術治療SUI已成了一大主流，全世界已 超過五十萬例之手術【5-11】。由於醫療技術之進步，在2003年起有學者嚐 試將TVT手術方法，改經閉鎖孔來放置尿道下束帶之手術，稱為 transobturator suburethral sling procedure (又稱為 TOT 手術或 MONARC 手術）【2，13】闼為此種手術方法比起TVT手術更為簡便，且不會傷害到膀 胱，也因此不必在手術中使用膀胱鏡，可縮短手術時間，更重要的是其成功率 與TVT手術非常相近，且同時擁有TVT手術之優點【13】。 如上述，自1995年TVT手術成為治療SUI之主流後，有關TVT手術之論 文非常的多，但針對TVT手術後，根據尿動力學所見去探討其成功之原理之文 章僅有數篇【14-17】唭中一篇即由我們所發表的「TVT手術治療女性真性 應力性尿失禁其手術前後的尿動力學所見之連續性評估」一文【17】哦們得 到在接受TVT手術後，病患之應力尿道壓圖之參數呈現有意義的增加，此為 TVT手術成功之重要原理。 因此，本計晝預計收集超過30例女性尿動力應力性失禁（urodynamic stress incontinence,過去稱為 genuine stress incontinence, GSI)【8】’在接 受TOT手術前及手術後3、6及12個月，每位病例均連續性接受全套尿動力 學檢查，包括尿流圖、注入及排空膀胱壓圖、肌電圖、應力尿道壓圖以及20 分鐘護墊測漏試驗【17】殘尿之測定則在病例作完尿流圖後，以導管作導尿 來決定。此所有的檢查均依照國際尿失禁防治協會（ICS)的良好尿動力學檢 查規則來實施【19】。我們將比較所有病例在TOT手術前及術後3、6、12個 月後之尿路動力學參數之變化，並以generaeized linear estimation of repeated measurement with Bonferroni’s multiple comparison test來 做統計學分析【17】。我們預期在此一前瞻性計晝可得到1〉TOT手術之成 功率（由護墊測漏試驗），2〉有無併發症及其比率，3〉尿路動力學參數有 無統計學上之變化以及其代表之意義。此一計晝具原創性，文獻上無此報告， 且在臨床診療上具有極大益處。The tension-free vaginal tape (TVT) operation for female stress urinary incontinence (SUI) was first introduced by Ulmstem in 1995 [1-3]. Although more than 150 kinds of operation for treating SUI have been reported [4], TVT operation has now become one of the most common operation for SUI due to its easy procedure, high success rate and low complication rate [5-11]. Due to the progress of surgical skill, a new method which uses transobturator foramen to put a sling under mid-urethra called transobturator suburethral sling procedure (TOT operation or MONARC operation) was introduced in 2003 [12,13]. This TOT operation is more easy to perform and it has no need to use cystoscopy intraoperatively when compared to TVT operation. Besides, its operation time is shorter than TVT operation and both have the very similar success rate [13]. Although TVT operation for treating SUI cases has become the main stream in recent years, there are only several reports to discuss the possible mechanism of success by this operation in literature [14-17]. We have reported that the significantly increased stress urethral pressure profile parameters may contribute to the high cure rate of TVT operation in 2004 [17]. Thus, we plan to recruit over 30 female patients with urodynamic stress incontinence, which was called genuine stress incontinence (GSI) before in this prospective study [18]. A detailed history will be recorded for each patient prior to physical examination and multi-channel urodynamic study. These patients will complete urodynamic study and 20-minute pad test before TOT operation and at 3, 6 and 12 months after operation. The sequential urodynamic findings of each patient will be compared and analyzed. All terminology and procedures conform to the standards recommended by International Continence Society or Urodynamic Society [19]. The generalized linear estimation of repeated measurement with Bonferroni’s multiple comparison test will be used for statistical analysis [17]. We expect this prospective study will conclude: 1) The success rate of TOT operation by pad test; 2) whether the presence of complication and its percentage; and 3) the sequential changes of urodynamic parameters and their significance. This study is an original one and no such report in literature so far. Besides, it will bring great significance in clinical practice.