Urinary retention after tension-free vaginal tape procedure: Incidence and treatment
Urinary retention after tension-free vaginal tape procedure: Incidence and treatment
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DOI：
10.1016/s0090-4295(01)01366-8
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发表时间：
2001-11-01
期刊：
影响因子：
2.1
通讯作者：
Klutke, J
中科院分区：
文献类型：
--
作者：
Klutke, C;Siegel, S;Klutke, J
目标。回顾我们在无张力阴道带（TVT）手术后持续尿潴留的经验，并报告我们的治疗结果。乌尔姆斯滕最近引进了TVT治疗女性压力性尿失禁。虽然发病率很低，但没有一种外科手术是没有风险的，经验可以更好地确定TVT手术的发病率。自1998年11月以来，我们共进行了600次TVT手术。其中，17例患者（2.8%）出现尿潴留或梗阻症状（包括犹豫、排空紧张或排空不完全的感觉），自手术之日起持续1周以上。我们回顾了手术记录，记录了手术时间、估计的出血量、膀胱穿透的存在以及任何报告的并发症。所有17例患者随后在门诊基础上经阴道释放。17例患者（平均年龄56岁，38 - 81岁）在TVT手术后平均64天（6 - 228天）解除吊带。所有患者均在24小时内完成排尿，并无进一步的出口梗阻主诉。没有受试者报告重新出现尿失禁或尿急。在每个患者中，估计失血量最小；手术时间平均为15分钟。发生1例尿道损伤，术中处理无后遗症。16名接受吊带释放的患者保持干燥；其余患者尿道损伤修复后，再次出现应激性尿失禁，并成功进行了简单的经阴道悬吊手术。出口梗阻是TVT手术的一个风险，在我们的经验中发生率为2.8%。TVT网片可以在局部麻醉下通过简单的阴道切口释放，迅速恢复正常排尿。虽然研究的患者数量很少，但在我们的研究中，应激性尿失禁在单纯释放后没有复发。(C) 2001, Elsevier Science Inc.；
Objectives. To review our experience with persistent urinary retention after the tension-free vaginal tape (TVT) procedure and report our treatment results. Ulmsten recently introduced the TVT procedure for female stress urinary incontinence. Although the morbidity is minimal, no surgical procedure is without risks, and experience will better define the morbidity of the TVT procedure.Methods. Since November 1998, we have collectively performed 600 TVT procedures. Of these, 17 patients (2.8%) developed urinary retention or symptoms consistent with obstruction (including hesitancy, straining to void, or feeling of incomplete emptying) lasting more than 1 week from the date of the procedure. We reviewed the operative record, noting the operative time, estimated blood loss, presence of bladder penetration, and any reported complications. All 17 patients subsequently underwent transvaginal release on an outpatient basis.Results. Seventeen patients (mean age 56 years, range 38 to 81) underwent sling release a mean of 64 days (range 6 to 228) after the TVT procedure. All patients voided to completion within 24 hours of release and reported no further subjective complaints of outlet obstruction. None of the subjects reported de novo urge incontinence or urgency. In each patient, the estimated blood loss was minimal; the operative time averaged 15 minutes. One urethral injury occurred and was managed intraoperatively without sequelae. Sixteen patients who underwent sling release have remained dry; the remaining patient, in whom a urethral injury was repaired, redeveloped stress incontinence and underwent an uncomplicated successful transvaginal sling procedure.Conclusions. Outlet obstruction is a risk of the TVT procedure and occurred with an incidence of 2.8% in our experience. The TVT mesh can be released by a simple vaginal incision under local anesthesia with rapid return to normal voiding. Although the number of patients studied was small, stress incontinence did not recur after uncomplicated release in our series. (C) 2001, Elsevier Science Inc.