Rodrigues Paulo, Hering Flávio
Division of Neurourology and Voiding Disturbances, Beneficência Portuguesa Hospital of São Paulo, Rua Teixeira da Silva 34-1 Andar, Conj 11, 04002-030 São Paulo, Brazil.
Int Urogynecol J. 2012 Feb;23(2):211-6. doi: 10.1007/s00192-011-1575-0. Epub 2011 Oct 1.
Iatrogenic female urethral obstruction resulting from sling operations may be related to surgical inexperience and must be better understood. Although there are no widely recognized parameters for this type of study, a single-surgeon consecutive series offers an opportunity to study the role of expertise in sling operations over time.
This study consecutively examined 176 women who underwent an autologous fascial sling procedure. Postoperative urethral obstruction was identified by the occurrence of voiding dysfunctions. Clinically obstructed patients were invited to undergo a postoperative urodynamic evaluation after 3 months. To enable comparison, patients were placed into 6-month groups according to the time of surgery.
A total of 159 cases were evaluated with a mean follow-up time of 32.4 ± 13.4 months. Stress continence was cured in 97.5% of cases. Although 29 patients were identified as obstructed, only 20 underwent a postoperative urodynamic evaluation. Only five of the clinically obstructed cases showed a high P(det)Q(max). All of the other cases met one or more of the non-classic parameters linked to obstruction. Overactive bladder was present in 14 (63.6%) of the obstructed cases. Iatrogenic urethral obstruction was more common among the early cases (30.4%) than among the later ones (5%) (P < 0.001). Postoperative urodynamic evaluation showed a trend toward obstruction on pressure flow studies.
Autologous fascial sling operations require expertise and involve a clear surgical learning curve. Iatrogenic obstruction in females does not fit a single model and may be difficult to recognize. Obstruction in females must be identified through clinical indicators and postoperative urinary complaints rather than the high detrusor pressure observed in men. Furthermore, iatrogenic female obstruction can probably be minimized but not eliminated.
吊带手术导致的医源性女性尿道梗阻可能与手术经验不足有关，对此必须有更深入的了解。尽管此类研究尚无广泛认可的参数，但单术者连续病例系列为研究随着时间推移专业技能在吊带手术中的作用提供了契机。
本研究连续纳入176例行自体筋膜吊带手术的女性。通过排尿功能障碍的发生情况确定术后尿道梗阻。临床诊断为梗阻的患者在3个月后接受术后尿动力学评估。为便于比较，根据手术时间将患者分为6个月一组。
共评估159例患者，平均随访时间为32.4±13.4个月。97.5%的病例压力性尿失禁得到治愈。尽管29例患者被诊断为梗阻，但仅20例接受了术后尿动力学评估。临床诊断为梗阻的病例中，只有5例显示最大逼尿肌压（P(det)Q(max)）升高。所有其他病例符合一项或多项与梗阻相关的非经典参数。14例（63.6%）梗阻病例存在膀胱过度活动症。医源性尿道梗阻在早期病例中（30.4%）比在后期病例中（5%）更常见（P<0.001）。术后尿动力学评估显示压力流研究有梗阻趋势。
自体筋膜吊带手术需要专业技能，且存在明确的手术学习曲线。女性医源性梗阻不符合单一模式，可能难以识别。女性梗阻必须通过临床指标和术后泌尿系统症状来识别，而非男性中观察到的高逼尿肌压力。此外，医源性女性梗阻或许可以降至最低，但无法消除。
