TVT手術における術中超音波検査

The usefulness of ultrasound guided tension-free vaginal tape（TVT）procedure

　腹圧性尿失禁に対するtension-free vaginal tape（TVT）手術において，術中超音波検査を試みた。2012年2～11月の間にTVT手術を行った22例を対象とした。経会陰，経腟走査により術中超音波検査を行い，尿道の解剖学的評価，恥骨後面の液性剝離の状態および挿入されたTVTテープを観察した。超音波検査において，恥骨，恥骨後面の液性剝離，膀胱を観察可能であった。これらを確認後に行った穿刺において，膀胱損傷は認めなかった。挿入後のTVTテープの位置，状態も超音波で観察可能であった。術中超音波検査を行うことにより，TVT手術の安全性かつ有効性に寄与することが示唆された。

Ultrasound guided tension-free vaginal tape（TVT）procedure was performed in 22 patients with stress urinary incontinence（SUI）from February 2012 to November 2012. TVT placement was performed following hydrodissection of the retropubic space. During TVT procedure, translabial and transvaginal ultrasonography were used to assess the morphology of the urethra, hydrodissection of the retropubic space and the positioning of the suburethral tape. Evaluation of the urethra by ultrasonography revealed that mean urethral length was 30.2（24.8～35.1）mm and the distance between the vaginal wall and the urethra was 8.8（7.3～10.5）mm. In 21 out of 22 patients, hypoechoic lesion was identified in the retropubic space, which was considered as effective hydrodissection. In one case who failed to show effective hydrodissection, transobturator tape procedure was performed. In all cases of TVT procedure, no bladder perforation occurred. Following TVT procedure, the position of suburethral tape was identified by ultrasonography. The subjective cure rate was 77.2％.