Natale F, La Penna C, Saltari M, Piccione E, Cervigni M
Department of Urogynecology, S. Carlo-IDI Hospital, Rome, Italy.
Minerva Ginecol. 2009 Apr;61(2):167-72.
Voiding dysfunction after incontinence surgery is a potential complication of all stress incontinence procedures. The term voiding dysfunction indicates from obstructive voiding symptoms up to complete urinary retention, requiring intermittent catheterization, and also includes irritative storage symptoms such as de novo urgency and detrusor overactivity. Of particular importance is the temporal relationship between symptoms and the previous surgical procedure, and although many different operations can result in voiding dysfunction, the most common cause remains attributable to hypersuspension of the urethra. The diagnosis of postoperative voiding dysfunction can be challenging. First of all surgeons must ask for an accurate history, in order to assess symptomatology and to carry out a physical examination. Further diagnosis could be done through urodynamics, but this is somewhat controversial: despite various proposed cut-off values, there are no absolute urodynamic criteria to define obstruction in women. Fortunately, most voiding dysfunction is transient and resolves spontaneously in a few days to weeks. Persistent voiding dysfunction (longer than 4 weeks) occurs in 5-20% after the Marshall-Marchetti-Krantz procedure, 4-22% after the Burch colposuspension, 5-7% after needle suspension, 4-10% after the pubovaginal sling procedure, and 2-4% after the trans-vaginal tape procedure. However, if symptoms persist, surgery is indicated. Several surgical approaches are described, including sling incision, sling lysis and formal urethrolysis, comprising vaginal and retropubic approach with or without graft interposition. In this article the procedures are described and the results of each type of urethrolysis are reported.
尿失禁手术后的排尿功能障碍是所有压力性尿失禁手术的潜在并发症。排尿功能障碍一词涵盖从梗阻性排尿症状到完全尿潴留（需要间歇性导尿），还包括诸如新发尿急和逼尿肌过度活动等刺激性储尿症状。症状与先前手术操作之间的时间关系尤为重要，尽管许多不同的手术都可能导致排尿功能障碍，但最常见的原因仍是尿道过度悬吊。术后排尿功能障碍的诊断可能具有挑战性。首先，外科医生必须询问准确的病史，以评估症状并进行体格检查。进一步的诊断可通过尿动力学检查完成，但这在一定程度上存在争议：尽管提出了各种临界值，但尚无绝对的尿动力学标准来定义女性的梗阻。幸运的是，大多数排尿功能障碍是短暂的，会在几天到几周内自行缓解。Marshall-Marchetti-Krantz手术术后持续性排尿功能障碍（超过4周）发生率为5%-20%，Burch阴道旁修补术后为4%-22%，针悬吊术后为5%-7%，耻骨后阴道吊带术术后为4%-10%，经阴道无张力尿道中段吊带术术后为2%-4%。然而，如果症状持续，则需进行手术。描述了几种手术方法，包括吊带切开术、吊带松解术和正规的尿道松解术，包括经阴道和耻骨后途径，有无植入物置入。本文描述了这些手术方法并报告了每种尿道松解术的结果。
