Abouassaly Robert, Steinberg Jordan R, Lemieux Marguerite, Marois Carlos, Gilchrist Lawrence I, Bourque Jean-Louis, Tu Le Mai, Corcos Jacques
Department of Urology, McGill University, Montreal, Quebec, Canada.
BJU Int. 2004 Jul;94(1):110-3. doi: 10.1111/j.1464-410X.2004.04910.x.
To analyse the complications of tension-free vaginal tape (TVT) surgery, a minimally invasive alternative for treating patients with stress urinary incontinence (SUI), at six institutions, and to review the management of these complications and their effect on patient outcome.
In all, 241 patients who had a TVT procedure by six urologists at six hospitals (two university and four community) were reviewed retrospectively by the same urologist. Complications during and after surgery, and their management, were analysed.
Complications during surgery included bladder perforation in 48 patients (5.8%) and blood loss > 500 mL in 16 (2.5%). Immediate complications after surgery were urinary retention (>24 h after) in 47 patients (19.7%), pelvic haematoma in four (1.9%) and suprapubic wound infection in one (0.4%). Of the 47 patients in retention, 32 were in retention for <48 h and treated with an indwelling catheter. The 15 remaining patients were treated with an indwelling catheter (one) or clean intermittent catheterization for a mean of 22 days. To correct the retention the TVT was released in seven patients and the tape sectioned in three. Late complications were de novo urgency, persistent suprapubic discomfort and intravaginal tape erosion in 36 (15%), 18 (7.5%) and one (0.4%) patient, respectively. Most of these complications resolved with observation and medical management, but intravaginal tape erosion required partial resection of the tape with closure and repair of the vaginal mucosa.
The present TVT complication rates were slightly higher than reported previously. This multi-institutional review in both academic and community hospitals may better reflect the morbidity of TVT insertion in clinical practice. TVT is a highly effective, minimally invasive method for treating SUI. A stricter definition of each complication and a better understanding of the mechanism of these complications may further improve the surgical outcome and decrease patient morbidity.
分析无张力阴道吊带术（TVT）的并发症，这是一种治疗压力性尿失禁（SUI）患者的微创替代方法，研究对象为六家机构的患者，并回顾这些并发症的处理及其对患者预后的影响。
由同一位泌尿科医生对六家医院（两家大学医院和四家社区医院）的六位泌尿科医生实施TVT手术的241例患者进行回顾性研究。分析手术期间及术后的并发症及其处理情况。
手术期间的并发症包括48例（5.8%）膀胱穿孔和16例（2.5%）失血超过500毫升。术后即刻并发症为47例（19.7%）尿潴留（术后超过24小时）、4例（1.9%）盆腔血肿和1例（0.4%）耻骨上伤口感染。在47例尿潴留患者中，32例尿潴留时间小于48小时，采用留置导尿管治疗。其余15例患者采用留置导尿管（1例）或清洁间歇性导尿，平均治疗22天。为纠正尿潴留，7例患者松开TVT，3例切断吊带。晚期并发症分别为36例（15%）新发尿急、18例（7.5%）持续性耻骨上不适和1例（0.4%）阴道内吊带侵蚀。这些并发症大多通过观察和药物治疗得到解决，但阴道内吊带侵蚀需要部分切除吊带并缝合和修复阴道黏膜。
目前TVT的并发症发生率略高于先前报道。这项在学术医院和社区医院进行的多机构研究可能更好地反映了临床实践中TVT植入的发病率。TVT是治疗SUI的一种高效、微创方法。对每种并发症进行更严格的定义并更好地理解这些并发症的机制可能会进一步改善手术效果并降低患者发病率。
