Kato Kumiko, Hirata Tomohiko, Suzuki Koichi, Yoshida Kazuhiko, Suzuki Shoji, Murase Tatsuro
Department of Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Nihon Hinyokika Gakkai Zasshi. 2005 Jul;96(5):568-71. doi: 10.5980/jpnjurol1989.96.568.
Tension-free vaginal tape (TVT), a less-invasive variation of the suburethral sling, has been rapidly gaining popularity worldwide in the treatment of female stress urinary incontinence. We report on two cases of bladder stones composed of fatty acid calcium following TVT operations. Case 1: A 76-year-old woman with a history of hysterectomy due to cervical cancer was suffering from vault prolapse. The insertion of a ring pessary lead to the development of stress urinary incontinence, and she was referred to our hospital. As she was frail, sexually inactive, and elderly, she underwent partial colpocleisis (Le Fort operation) combined with a TVT operation. One-month postoperative videourodynamics and chain cystourethrography (CUG) using olive oil as the lubricant showed cure of incontinence and mild support of the urethra. Her maximum flow rate was 18.8 ml/s and no residual urine was observed. Six months postoperatively she developed postmiction pain and pyuria that were not improved by antibiotics. Cystoscopy showed a small bladder stone, whose removal cured cystitis. Case 2: A 49-year-old woman, with a history of abdominal hysterectomy due to myoma uteri, visited our hospital complaining of stress urinary incontinence. A periurethral collagen injection was only temporarily effective, and she underwent a TVT operation. A 1-month postoperative evaluation including chain CUG using olive oil as the lubricant showed cure of incontinence, mild support of the urethra, a maximum flow rate of 28.8 ml/s, and no residual urine. Two months postoperatively she developed miction pain and pyuria that were solved by removing a small bladder stone. Anti-incontinence surgery increases the risk of developing bladder stones due to either foreign bodies (bladder erosion) or obstruction. However, neither of our cases had these conditions; instead, both bladder stones were composed of fatty acid calcium that appeared to be related to the olive oil used as the lubricant in chain CUG. Only four cases (including ours) of bladder stones composed of fatty acid calcium have been documented, but they may indicate that care is necessary when using olive oil as a contrast medium or lubricant in the urinary tract. When a woman with a history of anti-incontinence surgery has persisting or recurrent cystitis, cystoscopy should be performed to exclude bladder erosion and stones.
无张力阴道吊带术（TVT）是尿道下吊带术的一种微创术式，在女性压力性尿失禁的治疗中已在全球迅速普及。我们报告两例TVT手术后发生脂肪酸钙膀胱结石的病例。病例1：一名76岁女性，因宫颈癌行子宫切除术后出现穹窿脱垂。放置环形子宫托后出现压力性尿失禁，遂转诊至我院。鉴于她身体虚弱、无性活动且年事已高，接受了部分阴道封闭术（勒福特手术）联合TVT手术。术后1个月，使用橄榄油作为润滑剂进行的视频尿动力学检查和链式膀胱尿道造影（CUG）显示尿失禁治愈且尿道得到轻度支撑。她的最大尿流率为18.8毫升/秒，未观察到残余尿。术后6个月，她出现排尿后疼痛和脓尿，抗生素治疗无效。膀胱镜检查发现一枚小膀胱结石，取出结石后膀胱炎治愈。病例2：一名49岁女性，因子宫肌瘤行腹部子宫切除术后，因压力性尿失禁前来我院就诊。尿道周围胶原注射仅暂时有效，遂接受TVT手术。术后1个月的评估包括使用橄榄油作为润滑剂的链式CUG，结果显示尿失禁治愈、尿道得到轻度支撑、最大尿流率为28.8毫升/秒且无残余尿。术后2个月，她出现排尿疼痛和脓尿，取出一枚小膀胱结石后症状缓解。抗尿失禁手术因异物（膀胱侵蚀）或梗阻而增加发生膀胱结石的风险。然而，我们的两个病例均无这些情况；相反，两枚膀胱结石均由脂肪酸钙组成，似乎与链式CUG中用作润滑剂的橄榄油有关。仅有四例（包括我们的病例）脂肪酸钙膀胱结石的记录，但这可能表明在尿路中使用橄榄油作为造影剂或润滑剂时需谨慎。有抗尿失禁手术史的女性若持续或反复出现膀胱炎，应进行膀胱镜检查以排除膀胱侵蚀和结石。
