Sabadell Jordi, Poza Jose L, Esgueva Antonio, Morales Juan C, Sánchez-Iglesias Jose L, Xercavins Jordi
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
Int Urogynecol J. 2011 Dec;22(12):1543-7. doi: 10.1007/s00192-011-1490-4. Epub 2011 Jul 6.
This study was conducted to evaluate the effectiveness and safety of retropubic suburethral slings (TVT) to treat recurrent stress urinary incontinence (SUI) after transobturator tape (TOT) failure.
A descriptive study was performed among women with recurrent SUI treated at the Vall d'Hebron University Hospital between January 2006 and December 2009. All women were preoperatively evaluated to rule out complications of the first sling. Urodynamic testing was performed before and after the TOT procedure in all cases. Postoperative follow-up was performed at 1, 6, and 12 months and yearly thereafter. Outcomes were classified as cured, improved, or failed.
Twenty-three women were operated on over the study period. The median time to reoperation was 12 months (range 6 to 34 months) and the median follow-up time was 36.1 months (range 7.8 to 60.2 months). Overall cure and improvement rates were 86.4% at 12 and 24 months and 75% at 36 months. Failure was found not to be related to time between both sling surgeries. Two cases of bladder perforation were recorded (8.7%). Postoperative complications were slight and self-limited. De novo urgency occurred in five cases (21.7%).
TVT has been found to be effective to treat recurrent SUI after TOT failure in the present series with slight side effects.
本研究旨在评估耻骨后尿道下吊带术（TVT）治疗经闭孔尿道中段吊带术（TOT）失败后的复发性压力性尿失禁（SUI）的有效性和安全性。
对2006年1月至2009年12月在巴塞罗那比拉罗尔大学医院接受复发性SUI治疗的女性进行描述性研究。所有女性术前均接受评估以排除初次吊带术的并发症。所有病例在TOT手术前后均进行尿动力学检测。术后随访在1、6和12个月进行，此后每年进行一次。结果分为治愈、改善或失败。
在研究期间对23名女性进行了手术。再次手术的中位时间为12个月（范围6至34个月），中位随访时间为36.1个月（范围7.8至60.2个月）。12个月和24个月时的总体治愈率和改善率为86.4%，36个月时为75%。发现失败与两次吊带手术之间的时间无关。记录到2例膀胱穿孔（8.7%）。术后并发症轻微且为自限性。5例（21.7%）出现新发尿急。
在本系列研究中，已发现TVT治疗TOT失败后的复发性SUI有效，且副作用轻微。
