Duckett Jonathan, Baranowski Andrew
Department of Obstetrics and Gynaecology, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent ME7 5NY, UK.
Int Urogynecol J. 2013 Feb;24(2):195-201. doi: 10.1007/s00192-012-1863-3. Epub 2012 Jul 3.
Pain after suburethral sling insertion is an uncommon, but troublesome complication of continence surgery; in some cases it can cause significant distress and disability. It is often not recognised, poorly diagnosed and treated by gynaecologists and urologists unfamiliar with the condition.
A literature review was performed and the current evidence on pain after suburethral sling insertion reviewed.
The tension-free vaginal tape-obturator (TVT-O) procedure is associated with an increased incidence of early groin pain, but this often resolves with expectant management. Chronic pain may be difficult to treat. The injection of local anaesthetic and steroid solutions may provide relief in some patients. Cognitive behavioural therapy has a place in treatment. In resistant cases, surgical excision may be needed. Retropubic slings can be removed laparoscopically or by open exploration of the Cave of Retzius. Obturator tapes may require groin exploration.
Sling removal may result in recurrent incontinence and further tissue and nerve damage. It does not always cure pain and may exacerbate the problem.
尿道下吊带置入术后疼痛是一种少见但棘手的尿失禁手术并发症；在某些情况下，它会导致严重的痛苦和功能障碍。妇科医生和不熟悉该病症的泌尿科医生常常对此认识不足、诊断不佳且治疗不当。
进行文献综述，并对尿道下吊带置入术后疼痛的现有证据进行回顾。
无张力阴道吊带闭孔术（TVT - O）与早期腹股沟疼痛发生率增加相关，但这种疼痛通常通过观察等待处理可缓解。慢性疼痛可能难以治疗。局部麻醉剂和类固醇溶液注射可能会使一些患者症状缓解。认知行为疗法在治疗中占有一席之地。在难治性病例中，可能需要手术切除。耻骨后吊带可通过腹腔镜或经耻骨后间隙开放探查取出。闭孔带可能需要腹股沟探查。
取出吊带可能导致尿失禁复发以及进一步的组织和神经损伤。它并不总能治愈疼痛，反而可能使问题恶化。
