Long-term efficacy
ORIGINAL ARTICLE
Long-term efficacy of tension-free vaginal tape
in the management of stress urinary incontinence in women:efficacy at5-and7-year follow-up
A.Liapis&P.Bakas&G.Creatsas
Received:22February2008/Accepted:18May2008/Published online:10June2008
#The International Urogynecological Association2008
Abstract The objective of the study was to obtain a prospective assessment of the efficacy and the complica-tions associated with the use of tension-free vaginal tape (TVT)for the management of urodynamic stress inconti-nence at5-and7-year follow-up.Sixty-five female patients with stage I cystocele or less who have been operated with TVT procedure for management of urodynamic stress incontinence have been included in the study.At5-year follow-up,the objective cure rate was83%and failure rate 9.4%.At7-year follow-up,the objective cure rate was80% and the failure rate13.5%.De novo detrusor overactivity was seen in9.4%and11.4%of patients at5-and7-year follow-up,https://www.sodocs.net/doc/8e10791730.html,T operation is an effective and safe minimally invasive procedure for the management of urodynamic stress incontinence in women without signifi-cant cystocele in the long-term follow-up.The10-and20-year results are awaited.
Keywords Efficacy.Long term.Results.
Stress https://www.sodocs.net/doc/8e10791730.html,T.Urinary incontinence Introduction
The tension-free vaginal tape(TVT)is a relatively new procedure that has been designed for the surgical manage-ment of stress urinary incontinence in women.It has been introduced since1995[1]and has achieved worldwide popularity since then.The short-term results of the proce-dure have been encouraging[2]and are comparable to the Burch colposuspension,which is considered the most suc-cessful operation for stress urinary incontinence in women available to date.In addition,it is characterized by less operative time,significantly less surgical complications and postoperative voiding dysfunction,less hospitalization time,and faster recovery[3,4].During the last few years, the long-term results of TVT procedure started appearing in the literature[5],but there are limited data yet.In this study, we present our experience in relation to long-term efficacy of TVT procedure for the management of stress urinary incontinence in women.
Materials and methods
Seventy consecutive patients have been included in this study.It was estimated that,for a type I error-alpha0.10 and a type II error-beta0.10(power of the study90%)and an82%success rate for TVT at5years follow-up,null hypothesis value to detect a success rate of65%requires a sample size of at least54patients.
This prospective study took place in the2nd Department of Obstetrics and Gynecology of the University of Athens.All patients were asked via telephone call to come for follow-up and underwent postoperative urodynamic assessment.
All patients had a full history taken and a complete gynecological examination performed at initial visit,and frequency–volume charts were completed for2–4days. Preoperative urodynamic investigations included filling and voiding cystometry,uroflow,and1-h pad test.Stratification of severity of stress incontinence was based on the classifi-cation of pad weight gain suggested by the5th Report of the International Continence Society,Bristol,https://www.sodocs.net/doc/8e10791730.html,d to moderate urine loss was observed in31.4%of patients,
Int Urogynecol J(2008)19:1509–1512
DOI10.1007/s00192-008-0664-1
A.Liapis(*)
:P.Bakas:G.Creatsas
2nd Department of Obstetrics and Gynecology, Aretaieio Hospital,University of Athens,
N.Paritsi9A,N.Psichiko,
15451Athens,Greece
e-mail:p_bakas@https://www.sodocs.net/doc/8e10791730.html,
severe loss in45.8%,and very severe loss in22.8%of patients.Patient assessment at5-year follow-up included gynecological examination,filling and voiding cystometry, uroflow,and1-h pad test,and at7years follow-up included filling and voiding cystometry,uroflow,and a simple patient satisfaction questionnaire.Urodynamic stress incon-tinence diagnosis was based on the findings of urodynamic investigation.Diagnosis of detrusor overactivity was based on cystometric findings.All patients had USI with stage I prolapse or less of the anterior compartment according to the International Continence Society classification(ICSC). Patients with urodynamic findings of detrusor overactivity, previous operation in the genital tract or maximum urethral closure pressure of less than20cmH2O,prolapse of the anterior compartment greater than stage I according to ICSC,or prolapse of the middle or posterior compartment requiring management were excluded from the study.All patients were operated on with epidural anesthesia.All patients signed an informed consent,and approval of the hospital ethical committee was obtained.The outcome of the operation was assessed both subjectively and objec-tively.Objective assessment was based on the findings of cough stress test by asking the patient to cough with the bladder filled with400–450ml of normal saline or filled up to maximum cystometric capacity.At5-year follow-up, objective cure was considered as the absence of urine leaking during cough test in lithotomy or upright position and a pad test weight of<1g,and improvement as the reduction of urine loss to less than50%of urine loss they experienced before the operation.This was based on the findings of the1-h pad test.Subjective cure was defined as no loss of urine with exercise,coughing,or weight lifting and improvement as a subjectively significant reduction of the leaking episodes,expressed by patients’satisfaction. At7-year follow-up,objective cure was considered as the absence of urine leaking during cough test in lithotomy and upright position.In subjective cure,improvement and failure were assessed with the use of a simple question-naire that patients answered during their examination (“Appendix”).Statistical analysis was performed for vari-ables following normal distribution with the Student’s t test for independent samples and for variables not following normal distribution with the Mann–Whitney test for independent samples.A p<0.05was considered statistically significant.The software used for statistical analysis was Medcalc version7.6.0.0.
Results
Of the70patients,five were lost at5-year follow-up(three patients could not be located and two patients could not come for follow-up because they were living far away from the clinic).At7-year follow-up,four additional patients were excluded because two of them had died from natural causes and two were living in a nursing home and could not attend for follow-up.The patients’characteristics are shown in Table1.The objective cure rate was83%at5-years and 80%at7-year follow-up.In the objective cure rate at5-and 7-year follow-up,the patients having pure urge urinary incontinence have been included because they have been considered treated from their initial problem that was pure stress urinary incontinence.Total success rate,improve-ment,and failure rates at5-and7-year follow-up are presented in Tables2and3.Cystocele grade II or higher was seen in9.2%of patients at5-year follow-up and in 12.5%at7-year follow-up.
At5-year follow-up,de novo detrusor overactivity was seen in8%(5/65)of patients and urgency in12.3%(8/65) of patients.Out of the five patients with detrusor over-activity,one patient had mixed incontinence and four patients had urge urinary incontinence(6.5%).Three out of five patients complained of dysuria,but they had postvoid residual volume(PVR)of urine of less than 100ml and peak flow rates(PFRs)of17.8,13.4,and 13.8ml/s,respectively.
At7-year follow-up,de novo detrusor overactivity was seen in11.4%(7/61)of patients and urgency in19.6% (12/61).Out of seven patients with detrusor overactivity, two patients had mixed incontinence and five patients had urge urinary incontinence.Four out of seven patients complained of dysuria,and two of them had80and60ml PVR and13.4and13.8ml/s PFR,respectively,while the rest of the patients had PFR>15ml/s and PVR<100ml (Table4).At5-year follow-up,the median age of patients with bladder overactivity was72(range55–78),and at7-year follow-up the median age was72(range57–80). At7-year follow-up,overall subjective dysuria was14.7% (9/61),but PVR was normal(median5ml,range0–60ml), and PFR median was16.2ml/s(range13.4–24ml/s). Recurrent lower urinary tract infection was seen in3.2%of patients(2/61),but they had no complaints of dysuria or incontinence.
We had one case of TVT tape erosion developed at 29months postoperatively which was treated by cutting the TVT tape edges which were projecting through the vaginal Table1Patients’characteristics at7-year follow-up
Values(N=61) Age(years)58.1±10.4 Parity2±1.1
BMI26.8±2.3 Menopausal70.4%
BMI Body mass index
mucosa.The rest of the patients had no evidence of tape erosion at7-year follow-up.
Discussion
The introduction of TVT procedure for the management of stress urinary incontinence in women was based on the integral theory.According to such theory,the female urethra is closed at the level of the midurethra and not at the bladder https://www.sodocs.net/doc/8e10791730.html,ck of support of the midurethra from the pubourethral ligaments and from the suburethral anterior vaginal wall and defective function and insertion of pubococcygeal muscles predisposes one to stress urinary incontinence[6,7].The purpose of the TVT procedure is to reinforce the midurethral support,and it uses a polypro-pylene mesh tape that is inserted beneath and around the midurethra[8].
The efficacy of TVT procedure in the short term has been reassuring and very encouraging,and this is supported by several papers[2,9,10].
In the present study,the objective cure rate is83%,the objective improvement is7.8%,and the failure rate is9.2% at5-year follow-up,while there is no significant difference from the results of subjective assessment.These results are similar with the84.7%[11]and94.5%[12]for pure stress urinary incontinence that has been reported,and it is comparable with the78%for pure stress urinary inconti-nence that has been published[13].At7-year follow-up, the objective cure rate is80%,the objective improvement is 6.5%,and the failure rate is13%.These findings are comparable with the81.3%cure rate that has been reported by Nilsson et al.[14].De novo detrusor overactivity was seen in11.4%of patients,while in the Nilsson et al.series de novo urge symptoms were 6.3%.The presence of detrusor overactivity was not associated with significant obstructive findings from the lower urinary tract and could at least be partly attributed to the aging of the patients.
These findings support that TVT procedure maintains its very good short-term efficacy in the long term,and it is very satisfactory for the patients and the physicians.We had no significant intraoperative complications,and we had no patients with voiding difficulties in the long term.There was only one case of erosion of vaginal mucosa by TVT tape,which was treated by cutting the edges of the TVT tape,and the patient remained continent.Its clinical presentation was as a sharp foreign body in the vagina, making sexual intercourse for her husband painful.These results are comparable with the Burch colposuspension [15],while TVT procedure is much less invasive,with fast recovery time and low rate of complications.However, Burch colposuspension presents a time-dependent decline in its efficacy,having a surgical success decline to62%at more than10-year follow-up[16];at14or more years of follow-up,subjective cure rate could be reduced to44% [17].It has to be seen in the near future if the use of TVT tape as prosthetic material and the fibrotic tissue that is developed around it could maintain their function in the long term,preventing stress urinary incontinence.The incidence of de novo urgency at5-year follow-up was 12.3%,which is in agreement with the results published by Doo et al.[13]wherein they report11.5%incidence of de novo urgency and urge incontinence,higher than the6% incidence of de novo urgency reported by Chene et al.[12].
Table3Outcome of surgery at7-year follow-up
Values Percentage
Objective
Cure49/6180 Improvement4/61 6.5 Failure
Mixed incontinence2/61 3.2 USUI6/619.8 Subjective
Cured48/6178.7 Improved5/618.1 Failed8/6113.1 USUI Urodynamic stress urinary incontinence Table4Findings of filling and voiding cystometry at5-and7-year follow-up
5years
(65patients)
7years
(61patients)
p
First desire(ml)95.2±31.398.3±29.5 Maximum cystometric
capacity(ml)
363.2±60.7362.4±57.7NS
Maximal flow rate(ml/s)16.7±1.816.6±2NS Postvoid residual(ml)12.9±19.315.5±19.4NS NS No statistically significant difference
Table2Outcome of surgery at5-year follow-up
Values Percentage Objective
Cure54/6583 Improvement5/657.6 Failure
Mixed incontinence1/65 1.5 USUI5/657.6 Subjective
Cured55/6584.6 Improved3/65 4.6 Failed7/6510.7 USUI Urodynamic stress urinary incontinence
At7-year follow-up,the incidence of de novo urgency was 19.6%,while other studies have reported an incidence of de novo urge symptoms at6.3%[5].The higher incidence of de novo urgency in the present study could be possibly attributed to the relatively smaller number of patients studied compared to that of other studies and to the aging of patients,which could contribute to a higher incidence of de novo urgency.
TVT procedure maintains a high efficacy at5-and7-year follow-up,which is comparable with the Burch colposuspension,but its efficacy at10-and20-year follow-up remains to be https://www.sodocs.net/doc/8e10791730.html,T procedure for the management of urodynamic stress incontinence appears to be a cost-effective technique at5-and7-year follow-up. Conflicts of interest None.
Appendix
1.Do you feel cured from your stress urinary incontinence
after the operation you had?
YES NO
2.Do you think that your incontinence has been improved
after the operation you had?
YES NO
3.Do you think that you are about the same or worse after
your operation for the management of your stress urinary incontinence
About the same YES NO
Worse YES NO
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基于单片机的水位控制系统毕业论文
基于单片机的水位控制系统 毕业论文 目录 河系学院本科生毕业论文（设计）诚信声明........................... 错误!未定义书签。河西学院本科生毕业论文（设计）开题报告........................... 错误!未定义书签。摘要............................................................ 错误!未定义书签。ABSTRACT ........................................................ 错误!未定义书签。 1. 绪论 (2) 1.1 研究背景 (2) 1.2研究现状 (2) 2.设计任务及要求分析 (3) 2.1 设计任务及要求 (3) 2.1.1 设计任务 (3) 2.1.2 设计要求 (3) 2.1.3 要求分析 (3) 3. 系统方案论证与选择 (3) 3.1方案设计 (3) 3.2 系统整体方案 (5) 3.2 各单元电路方案论证 (5) 3.3 主要模块简介 (7) 3.3.1 核心芯片STC89C51单片机 (7) 3.3.2 1602液晶显示器 (9) 4. 硬件电路设计 (13) 4.1 单片机最小硬件系统电路 (13) 4.2水位显示电路 (13) 4.3 水位调整及其报警电路 (15) 4.4初值设置按键电路 (15) 5. 程序设计 (16) 5.1水位控制系统主程序设计流程图 (16) 5.2 水位控制系统主程序 (16) 6. 实物调试与测试 (16) 6.1实物图 (17) 6.2 测试结果分析 (17) 7. 结束语 (17) 参考文献 (18) 致谢 (20) 附录 (21) 河西学院本科生毕业论文（设计）题目审批表 (29)
河西学院学分制学籍管理规定(试行)
河西学院学分制学籍管理规定（试行） 第一章总则 一、为维护我校正常的教育教学秩序，促进学生德、智、体、美全面发展，不断提高教学质量，依据国家有关法律、法规和教育行政管理部门有关规定，结合我校实际，特制定本管理规定。 二、本实施细则适用于我校有正式学籍的全日制本科在校学生的管理。 三、为适应不同层次学生的需求，我校实行弹性学制。 第二章目的 实施学分制的目的： 一、提高学生素质并满足不同层次学生学习知识的要求。 二、引导学生自我设计和选择成才方向，促进学生的个性发展。 三、调动学生学与教师教的积极性，进一步提高教育教学质量。 四、充分利用我校的各类教学资源，提高办学效益。 第三章学制与学期 一、学制：本科标准学制为4年，实行3－6年的弹性学制。学生取得学籍后，在3--6年学习年限内修业，可提前至3年毕业，也可延长至6年毕业，累计在校学习时间最长不得超过6年。具有学籍的时间最长不得超过8年。 二、每学年为两个学期，共40周，其中教学时间36周（每学期18周），考试时间4周（每学期2周），并在适当时间安排入学教育、军事训练、生产劳动、社会实践等活动。 第四章课程设置与学分 一、按人才培养方案的规定，我校各专业的课程结构设置分为三个平台：校级平台课程、系级平台课程和专业平台课程。 二、学分制是一种教学管理制度，以学分作为计算学生学习量多少的单位，以成绩绩点作为衡量学生学习质量优劣的指标，以取得必要最低学分作为毕业标准。各专业学生毕业时应达到的最低总学分为160-170学分（具体学分要求按各专业人才培养方案规定执行）。 三、各类课程学分分配的原则要求如下：
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基于单片机的水位控制系统设计毕业论文
基于单片机的水位控制系统设计毕业论文 目录 河系学院本科生毕业论文（设计）诚信声明 (2) 河西学院本科生毕业论文（设计）开题报告 (3) 摘要 (6) ABSTRACT (6) 1. 绪论 (7) 1.1 研究背景 (7) 1.2研究现状 (7) 2.设计任务及要求分析 (8) 2.1 设计任务及要求 (8) 2.1.1 设计任务 (8) 2.1.2 设计要求 (8) 2.1.3 要求分析 (8) 3. 系统方案论证与选择 (8) 3.1方案设计 (8) 3.2 系统整体方案 (10) 3.2 各单元电路方案论证 (10) 3.3 主要模块简介 (11) 3.3.1 核心芯片STC89C51单片机 (11) 3.3.2 1602液晶显示器 (14) 4. 硬件电路设计 (17)
4.1 单片机最小硬件系统电路 (18) 4.2水位显示电路 (18) 4.3 水位调整及其报警电路 (19) 4.4初值设置按键电路 (20) 5. 程序设计 (20) 5.1水位控制系统主程序设计流程图 (20) 5.2 水位控制系统主程序 (20) 6. 实物调试与测试 (21) 6.1实物图 (21) 6.2 测试结果分析 (21) 7. 结束语 (22) 参考文献 (23) 致谢 (24) 附录 (25) 河西学院本科生毕业论文（设计）题目审批表 (33) 河西学院物理与机电工程学院指导教师指导毕业论文情况登记表 (34) 河西学院毕业论文（设计）指导教师评审表 (35) 河西学院本科生毕业论文（设计）答辩记录表 (36)
1. 绪论 1.1 研究背景 水位自动控制技术越来越频繁地进入到自动控制系统设计者的视线。传统的水位控制系统虽结构简单,但功能单一,无法实现人机交互,且通用性差。如今随着电子技术的飞速发展,电子产品制造工艺成熟,批量生产降低了产品价格。人们开始意识到采用单片机来实现水位控制。其人机交互性强, 功能强大, 控制精度高, 能够方便地与上位机通讯, 实现数据共享。且价格低廉, 通用性、实用性强, 能够在稍作改造后或直接用于诸如自来水厂的储水池、爆气池, 污水处理厂、化学工厂的各类液体池以及电厂一的锅炉气泡等需要水位自动控制的场合。 1.2研究现状 在许多工业生产系统中，需要对系统的液位或物料位进行监测，特别是对具有腐蚀性的液体液位的测量，传统的电极法是采用差位分布电极，通过给电脉冲来检测液面，电极长期浸泡在液体中，极易被腐蚀、电解、失去灵敏性，因而对测试设备的抗腐蚀性要求较高。超声波液位检测系统，利用了超声波传感技术的原理，采取一种非接触式的测量方法，能够实现对工业系统中液位或物料位的检测；而且超声波具有很好的指向性和束射特性，人耳听不见，一般不会对人体造成伤害检测工程方便、迅速、易做到实时控制，而且测量精度又能达到工业实用的要求，所以有广泛的工业应用前景。 并且目前，我国住宅小区楼房自来水供水系统主要采用高塔供水，既在楼顶或者另外建设的高塔上面建个蓄水池以保证用户水压的恒定。目前大多数的住宅小区都是采用人工加水的办法，即当水用完的时候，就人工开启水泵进行加水，十分不便。所以这一切问题的存在，都在呼唤一种简单经济的水位检测报警控制系统的诞生。 传统的控制方式存在控制精度低、能耗大的缺点,而自动控制原理, 依据用水量的变化自动调节系统的运行参数,保持水压恒定以满足用水要求, 从而提高了供水系统的质量，而且成本低，安装方便，经过多次实验证明，灵敏性好，是节约水源，方便家庭和单位控制水位的理想装置。
毕业论文开题报告模板范文
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大学生孤独感论文
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