Amundsen C L, Guralnick M L, Webster G D
Divisions of Gynecologic Specialties and Urology, Duke University Medical Center, Durham, North Carolina, USA.
J Urol. 2000 Aug;164(2):434-7.
We evaluated the success of several techniques for treating urethral obstruction and erosion after a pubovaginal sling procedure.
Between April 1998 and June 1999, 32 women 33 to 79 years old (average age 62) who underwent a pubovaginal sling procedure with various materials were referred for the assessment of urethral obstruction. Patients were evaluated with a urogynecologic history, physical examination, voiding diary, cystoscopy and video urodynamics. Surgical procedures to resolve urethral obstruction were performed transvaginally and the specific techniques used were based on the type of sling material, urethral erosion and concomitant stress incontinence or other urethral pathology. Outcome measures were assessed by disease specific quality of life questionnaires, voiding diary and urogynecologic questionnaire.
Preoperatively 30 of the 32 women (93.7%) noticed urge incontinence, 20 (62.5%) performed intermittent self-catheterization, 6 (18.7%) had an indwelling catheter and 3 (9%) complained of concomitant stress urinary incontinence. After the sling takedown 29 patients (93.5%) achieved efficient voiding within week 1 postoperatively. Urge incontinence symptoms resolved in 20 cases (67%) but stress incontinence developed in 3 (9%). Of the 32 women 27 (84%) indicated that continence was much better than before the initial sling procedure.
Managing urethral obstruction after a pubovaginal sling procedure is challenging. Using various techniques based on sling material, urethral erosion and bladder neck integrity a successful outcome is possible in the majority of cases.
我们评估了几种治疗耻骨后阴道吊带术后尿道梗阻和糜烂的技术的成功率。
1998年4月至1999年6月，32名年龄在33至79岁（平均年龄62岁）、使用各种材料进行耻骨后阴道吊带术的女性因尿道梗阻接受评估。通过泌尿妇科病史、体格检查、排尿日记、膀胱镜检查和影像尿动力学对患者进行评估。经阴道进行解决尿道梗阻的手术，所使用的具体技术基于吊带材料的类型、尿道糜烂以及是否伴有压力性尿失禁或其他尿道病变。通过疾病特异性生活质量问卷、排尿日记和泌尿妇科问卷评估结果指标。
术前，32名女性中有30名（93.7%）有急迫性尿失禁，20名（62.5%）进行间歇性自我导尿，6名（18.7%）留置导尿管，3名（9%）伴有压力性尿失禁。吊带拆除后，29名患者（93.5%）在术后第1周内实现有效排尿。20例（67%）急迫性尿失禁症状消失，但3例（9%）出现压力性尿失禁。32名女性中有27名（84%）表示控尿情况比初次吊带手术前好得多。
处理耻骨后阴道吊带术后的尿道梗阻具有挑战性。根据吊带材料、尿道糜烂和膀胱颈完整性采用各种技术，大多数情况下有可能获得成功的结果。
