Rutman Matthew P, Deng Donna Y, Shah Sovrin M, Raz Shlomo, Rodríguez Larissa V
Department of Urology, Columbia University School of Medicine, New York, New York, USA.
J Urol. 2006 May;175(5):1794-8; discussion 1798-9. doi: 10.1016/S0022-5347(05)00988-2.
Female patients with severe urethral incompetence are a unique surgical challenge. Urethral closure and continent diversion are often the next step in the treatment of these patients. We present a technique that provides circumferential coaptation of the urethra as a salvage procedure in this severe subset of patients.
We prospectively evaluated 47 patients who had a spiral sling. A 1 x 15 cm piece of soft polypropylene mesh was prepared with a zero polyglactin suture applied at each end. A clamp was used to pass the mesh between the urethra and pubis. The ends of the mesh were crossed at the ventral aspect of the urethra, creating a complete circle around the urethra. The sutures were transferred to the suprapubic area and tied without tension. The surgical outcome was determined by patient self-assessment, including symptom, bother and quality of life questionnaires.
Mean patient age was 59 years. At presentation patients had undergone a mean of 2.6 incontinence procedures and wore a mean of 6 pads daily. Mean daily pad use decreased to 0.9 (p <0.005). Preoperatively mean SUI symptom severity and bother scores were 2.8 and 2.9, respectively, on a scale of 0--none to 3--severe. Postoperatively these values decreased to 0.6 and 0.4, respectively (each p <0.005). There was a mean 87% overall improvement in symptoms.
The spiral sling is an effective salvage transvaginal procedure that may be considered in a small subset of female patients with a nonfunctional urethra as a last resort before urethral closure procedures.
患有严重尿道功能不全的女性患者是独特的手术挑战。尿道闭合术和可控性改道通常是这些患者治疗的下一步。我们介绍一种技术，该技术可对尿道进行环形贴合，作为这一严重亚组患者的挽救性手术。
我们前瞻性评估了47例接受螺旋吊带手术的患者。准备一块1×15厘米的软聚丙烯网片，两端各应用一根零聚乙醇酸缝线。使用夹子将网片穿过尿道和耻骨之间。网片的两端在尿道腹侧交叉，在尿道周围形成一个完整的环。缝线转移到耻骨上区域并无张力打结。手术结果由患者自我评估确定，包括症状、困扰和生活质量问卷。
患者平均年龄为59岁。就诊时患者平均接受了2.6次尿失禁手术，每天平均使用6片尿垫。平均每日尿垫使用量降至0.9片（p<0.005）。术前平均SUI症状严重程度和困扰评分分别为2.8分和2.9分，评分范围为0（无）至3（严重）。术后这些值分别降至0.6分和0.4分（均p<0.005）。症状总体平均改善87%。
螺旋吊带是一种有效的经阴道挽救性手术，对于一小部分尿道无功能的女性患者，在进行尿道闭合手术之前，可作为最后的选择加以考虑。
