Vaginal excision of the sub-urethral sling: analysis of indications, safety and outcome.
Vaginal excision of the sub-urethral sling: analysis of indications, safety and outcome.
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DOI：
10.5114/aoms.2014.42305
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发表时间：
2015-10-12
期刊：
影响因子：
--
通讯作者：
Barcz E
中科院分区：
文献类型：
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作者：
Fabian G;Kociszewski J;Kuszka A;Fabian M;Grothey S;Zwierzchowska A;Majkusiak W;Barcz E
吊带技术是治疗压力性尿失禁的首选方法，尽管并发症发生率高，有时需要再次手术，而胶带横切和切除是最重要的。本研究旨在分析经阴道悬吊带切除术的适应证、技术和效果。对100例经手术切除Krankenhaus Hagen-Haspe尿道下吊带的患者进行了回顾性研究。分析的指标为：吊带类型、症状发作、特殊并发症发生率、手术安全性和结果。并发症多发生在术后2年内。最常见的再次手术指征是：膀胱过度活动(%)、持续性压力性尿失禁(59%)、疼痛(40%)、尿潴留(40%)和糜烂(29%)。部分并发症(如阴道糜烂伴术后疼痛、感染伴尿潴留)并存。术中膀胱损伤1例，血肿1例。在OAB患者中，24小时尿频从13.3%降至8.5%(P<；0.001)，平均排尿量从131.7增至216.4毫升(P<；0.001)，夜间尿量从3.28%增至1.19%(P<；0.001)。在10分视觉评分(p<；0.001)中，紧迫感的强度从8.78降至0.92.40名患者中有39名疼痛和尿潴留得到缓解(p<；0.0001)。自杀性尿失禁发生率从59%上升到83%(p<；0.001)。吊带取出是安全的，并发症发生率最低。取出胶带可以解决大多数并发症，但SUI会复发或恶化。
Sling techniques are the method of choice in stress urinary incontinence management, despite the high rates of complications leading sometimes to the necessity of re-operation, and the tape transection and resection are of the greatest importance. The study was aimed at analyzing the indications, technique and effects of transvaginal tape excision. A retrospective study including 100 patients who underwent surgical removal of the sub-urethral sling in Evangelisches Krankenhaus Hagen-Haspe was conducted. The analyzed measures were: sling type, onset of symptoms, rates of particular complications, safety and outcome of the operative procedure. Most complications occurred in the first 2 years after surgery. The most common indications for re-operation were: overactive bladder (OAB) (64%), persistent stress urinary incontinence (SUI) (59%), pain (40%), urinary retention (40%), and erosion (29%). Some of the complications co-existed (i.e. vaginal erosion with postoperative pain, infections with urinary retention). During the procedure 1 bladder was injured and 1 patient had a hematoma. In women with OAB, 24-hour frequency decreased from 13.3 to 8.5 (p < 0.001), the mean voiding volume increased from 131.7 to 216.4 ml (p < 0.001), and nocturia increased from 3.28 to 1.19 (p < 0.001). Intensity of urgency decreased from 8.78 to 0.92 in the 10-point visual score (p < 0.001). Pain and urinary retention resolved in 39 out of 40 patients (p < 0.0001). The rate of SUI increased from 59% to 83% (p < 0.001). Sling removal is safe and associated with a minimal rate of complications. Removing the tape causes resolution of most of the complications, but SUI recurs or worsens.