Delorme E, Hermieu J-F
Service d'Urologie, Polyclinique de Bourgogne, BP 315, 71108 Chalons-sur-Saône cedex, France.
Prog Urol. 2010 Feb;20 Suppl 2:S132-42. doi: 10.1016/S1166-7087(10)70007-5.
The complications of suburethral slings are rare but varied. The operative complications result most often from errors in surgical technique. Intraoperative cystoscopy is required when implanting a retropubic sling to diagnose vesical transfixion intraoperatively. Functional complications are the most frequent. They require a true diagnostic strategy before proposing treatment adapted to the patient. The first examination should be an endoscopic urethrovesical exploration to eliminate vesicourethral transfixion by the suburethral slings. Acute postoperative retention most often stems from surgical relaxation of the suburethral slings during the immediate postoperative period. Dysuria is more easily reversed if it is treated early with resection or ablation of the suburethral slings. De novo urge incontinence has many etiologies : infection, urethral obstruction, more rarely cystocele, and idiopathic causes. With recurrent stress incontinence after suburethral slings, management will depend on anamnesis, as well as the clinical and urodynamic workups. The treatment could involve the sling (second suburethral sling, kinking of the suburethral sling); however, another therapeutic alternative will have to be suggested relatively early (artificial sphincter, ACT balloons, etc.). The recommended use of the large-mesh knitted monofilament polypropylene suburethral sling has considerably reduced the risk of infectious complications related to the prosthetic material. In case of vaginal erosion, prosthesis infection must be eliminated, which requires removing the sling. Simple erosion can be treated with partial resection of the exposed sling and vaginal suture. Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapse, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.
耻骨后吊带术的并发症罕见但多样。手术并发症大多源于手术技术失误。植入耻骨后吊带时，术中需进行膀胱镜检查以诊断术中膀胱穿刺。功能并发症最为常见。在提出适合患者的治疗方案之前，需要一个真正的诊断策略。首次检查应进行内镜下尿道膀胱探查，以排除耻骨后吊带导致的膀胱尿道穿刺。急性术后尿潴留最常见的原因是术后早期耻骨后吊带手术松解。如果早期通过切除或消融耻骨后吊带进行治疗，排尿困难更容易得到缓解。新发急迫性尿失禁有多种病因：感染、尿道梗阻，较少见的有膀胱膨出及特发性病因。对于耻骨后吊带术后复发性压力性尿失禁，治疗将取决于病史以及临床和尿动力学检查结果。治疗可能涉及吊带（再次耻骨后吊带术、耻骨后吊带扭结）；然而，相对较早地就必须提出另一种治疗选择（人工括约肌、ACT球囊等）。推荐使用大网孔编织单丝聚丙烯耻骨后吊带，这已大大降低了与假体材料相关的感染并发症风险。出现阴道侵蚀时，必须消除假体感染，这需要取出吊带。单纯侵蚀可通过部分切除外露吊带及阴道缝合进行治疗。已报道了许多非吸收性姑息治疗方法，通常病例数较少。它们可分为三种类型：尿道外阻塞装置、尿道内阻塞装置和阴道内支撑装置。可以建议使用子宫托或其他阴道装置，特别是在伴有脱垂的情况下，当漏尿非常偶尔出现（如运动等）或患者无法进行其他治疗时可使用。
