Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Urol. 2011 Mar;185(3):993-7. doi: 10.1016/j.juro.2010.10.050. Epub 2011 Jan 19.
We evaluated the safety of a mid urethral sling postoperative care pathway using patient subjective reporting of force of stream to minimize length of stay and catheter placement.
Women undergoing solitary mid urethral sling surgery were prospectively enrolled in our study. Force of stream after the sling therapy protocol consisted of retrograde bladder filling with 300 ml fluid within 1 hour after surgery. Patients rated force of stream compared to baseline on a visual analog scale. Those with a force of stream of 50% or greater were immediately discharged home regardless of post-void residual urine volume. Only those unable to void and those rating force of stream less than 50% with post-void residual urine volume greater than 500 ml were discharged home with a catheter. Patients were telephoned within 1 week of surgery and seen 4 to 6 weeks postoperatively. The primary outcome was unexpected visits to the emergency room or office for voiding dysfunction or urinary retention.
A total of 114 women were prospectively enrolled in our study, of whom 105 (92.1%) passed the protocol and were discharged home without a catheter. Of the patients 14 were discharged home with increased post-void residual urine volume (range 152 to 427 ml) but no catheter, representing those who would have been discharged with a catheter by many traditional voiding protocols. According to protocol 9 patients were discharged with a catheter. No patient presented to the emergency room or office in urinary retention or with voiding dysfunction before the scheduled visit.
Patients who report a force of stream of 50% or greater can be safely and rapidly discharged home after an uncomplicated mid urethral sling procedure regardless of post-void residual urine volume. Scanned post-void residual urine volume does not add much value in those who can void. By following the force of stream after sling therapy protocol patients can be discharged home less than 3 hours after mid urethral sling surgery.
我们评估了一种经尿道中段吊带术后护理途径的安全性，通过患者主观报告尿流力量来尽量减少住院时间和导尿管放置。
前瞻性纳入接受单纯经尿道中段吊带手术的女性患者。吊带治疗方案后，在术后 1 小时内用 300ml 液体逆行膀胱充盈，患者用视觉模拟评分法（VAS）对尿流力量与基线进行比较。尿流力量≥50%的患者立即出院，无论残余尿量如何。只有不能排尿且尿流力量＜50%且残余尿量＞500ml 的患者，才会携带导尿管出院。术后 1 周内电话随访患者，4-6 周后门诊随访。主要结局是因排尿功能障碍或尿潴留而意外到急诊室或诊所就诊。
共有 114 例女性前瞻性纳入研究，其中 105 例（92.1%）通过方案并在无导尿管的情况下出院回家。14 例患者出院时残余尿量增加（范围 152-427ml），但无导尿管，这代表了许多传统排尿方案下需要携带导尿管出院的患者。根据方案，9 例患者携带导尿管出院。在预定就诊前，没有患者因尿潴留或排尿功能障碍而到急诊室或诊所就诊。
在经历了单纯经尿道中段吊带手术后，报告尿流力量≥50%的患者可以安全、快速地出院回家，无论残余尿量如何。在能够排尿的患者中，扫描残余尿量并没有太大的价值。通过遵循吊带治疗方案后的尿流力量，患者可以在经尿道中段吊带手术后不到 3 小时出院。
