Patterson Danielle, Rajan Sujatha, Kohli Neeraj
From the Division of Urogynecology, Brigham and Women's Hospital, Boston, MA.
Female Pelvic Med Reconstr Surg. 2010 Sep;16(5):307-9. doi: 10.1097/SPV.0b013e3181ed3fc3.
: Management of recurrent stress urinary incontinence (SUI) after synthetic mid-urethral sling placement is a challenging clinical dilemma. This case series describes a safe, minimally invasive treatment option for recurrent SUI after failure of the primary mid-urethral sling procedure.
: Twenty women with recurrent SUI after previous synthetic mid-urethral sling placement underwent plication of the sling with 2-0 polyester suture under intravenous sedation with an intra-operative cough stress test between December 2004 and December 2008. A retrospective chart review was performed to obtain pertinent preoperative and postoperative data.
: Nine of the patients had prior retropubic synthetic mid-urethral slings. The other 11 women had transobturator mid-urethral slings, 10 of whom had slings via the outside-in approach and 1 had a single-incision mini-sling placed. The mean patient age was 59.8 years (range 38-83 years). Sling plication was performed at a median of 159.5 days after initial sling placement (range 26-2090 days). Overall 85% of patients had subjective improvement in SUI after sling plication with a median follow-up of 54.5 days (range 29-972 days). Those patients with prior retropubic slings had a 100% improvement rate compared to 72% improvement with prior obturator slings (P = 0.22). The subjective cure rate was 65%, 88% for the retropubic slings and 45% for the transobturator slings (P = 0.07). There were no complications.
: Midline plication of previously placed synthetic mid-urethral slings is a safe and effective method of treating recurrent SUI.
合成材料经阴道无张力尿道中段悬吊带术（mid-urethral sling，MUS）后复发性压力性尿失禁（stress urinary incontinence，SUI）的处理是一个具有挑战性的临床难题。本病例系列描述了一种针对初次MUS手术失败后复发性SUI的安全、微创治疗选择。
2004年12月至2008年12月期间，20例既往接受过合成材料经阴道无张力尿道中段悬吊带术的复发性SUI患者在静脉镇静下，使用2-0聚酯缝线对吊带进行折叠，并进行术中咳嗽压力试验。通过回顾性病历审查获取相关术前和术后数据。
9例患者曾接受耻骨后合成材料经阴道无张力尿道中段悬吊带术。另外11例女性接受了经闭孔尿道中段悬吊带术，其中10例通过由外向内法放置吊带，1例放置了单切口迷你吊带。患者平均年龄为59.8岁（范围38 - 83岁）。吊带折叠手术在初次吊带放置后中位数为159.5天进行（范围26 - 2090天）。总体而言，85%的患者在吊带折叠术后SUI有主观改善，中位随访时间为54.5天（范围29 - 972天）。既往接受耻骨后吊带术的患者改善率为100%，而既往接受闭孔吊带术的患者改善率为72%（P = 0.22）。主观治愈率为65%，耻骨后吊带术患者为88%，经闭孔吊带术患者为45%（P = 0.07）。无并发症发生。
对先前放置的合成材料经阴道无张力尿道中段悬吊带进行中线折叠术是治疗复发性SUI的一种安全有效的方法。
