Kuhn Annette, Eggeman Caroline, Burkhard Fiona, Mueller Michael D
Department of Gynaecology, University Hospital Bern and University of Bern, Switzerland.
Eur Urol. 2009 Aug;56(2):371-6. doi: 10.1016/j.eururo.2008.07.001. Epub 2008 Jul 11.
Suburethral slings are commonly used for the surgical treatment of female stress incontinence; occasionally they can cause erosion and dyspareunia.
The primary aim of this study is to determine the outcome after reclosure of the vaginal epithelium for suburethral sling erosion. Sexual function was assessed before and after intervention using the Female Sexual Function Index (FSFI) questionnaire.
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective case-controlled study in which, between December 2005 and December 2007, we included patients who were referred to the Department of Urogynaecology because of vaginal erosion after suburethral sling insertion for urinary stress incontinence. For evaluation of sexual function, all patients filled in an FSFI questionnaire before intervention and at follow-up. All patients underwent gynaecological examination including colposcopy, and the site and size of the defect were noted.
The edge of the vaginal epithelium was trimmed, mobilized, and closed with interrupted vertical Vicryl mattress sutures in a single layer.
FSFI questionnaire and clinical findings.
Twenty-one patients were included in the study. Eighteen patients with larger defects were operated on, and three defects healed after topical application of estrogen cream. In 16 patients, the defect had healed at follow-up; two patients with persisting defects were brought back to surgery and the procedure was repeated, paying particular attention to tension-free adaptation of vaginal tissue. In one patient, partial sling removal was performed after the second failed intervention. The domains of desire (p<0.0001), arousal (p<0.0003), lubrication (p<0.0001), satisfaction (p<0.0130), and pain (p<0.0001) improved significantly. Orgasm remained unchanged (p=0.4130; all two-tailed t-test).
Suburethral erosion can be treated effectively by resuturing. Sexual function is improved in regard to desire, arousal, lubrication, satisfaction, and pain, but not orgasm. In septic patients and patients with a history of radiation, grossly infected tissue, or severe pain, excision of the mesh needs to be considered.
尿道下吊带常用于女性压力性尿失禁的外科治疗；偶尔会导致糜烂和性交困难。
本研究的主要目的是确定尿道下吊带糜烂后阴道上皮重新闭合的效果。使用女性性功能指数（FSFI）问卷在干预前后评估性功能。
设计、地点和参与者：这是一项前瞻性病例对照研究，在2005年12月至2007年12月期间，我们纳入了因尿道下吊带插入治疗尿失禁后出现阴道糜烂而转诊至泌尿妇科的患者。为了评估性功能，所有患者在干预前和随访时填写FSFI问卷。所有患者均接受妇科检查，包括阴道镜检查，并记录缺损的部位和大小。
修剪、游离阴道上皮边缘，用间断垂直的薇乔褥式缝线单层缝合。
FSFI问卷和临床检查结果。
21例患者纳入研究。18例缺损较大的患者接受了手术，3例缺损在局部应用雌激素乳膏后愈合。16例患者在随访时缺损已愈合；2例持续存在缺损的患者再次接受手术，重复该操作，特别注意阴道组织的无张力贴合。1例患者在第二次干预失败后进行了部分吊带取出术。性欲（p<0.0001）、性唤起（p<−0.0003）、润滑（p<0.0001）、满意度（p<0.0130）和疼痛（p<0.0001）等方面有显著改善。性高潮无变化（p=0.4130；均为双侧t检验）。
尿道下糜烂可通过重新缝合有效治疗。在性欲、性唤起、润滑、满意度和疼痛方面性功能有所改善，但性高潮无改善。对于脓毒症患者以及有放疗史、严重感染组织或剧痛的患者，需要考虑切除补片。
