Rusavy Z, Rivaux G, Fatton B, Cayrac M, Boileau L, de Tayrac R
Department of Obstetrics and Gynecology, The Faculty of Medicine and Teaching Hospital in Pilsen, Charles University in Prague, GPK FN Plzeň, Alej Svobody 80, Pilsen, 304 60, Czech Republic.
Int Urogynecol J. 2013 Aug;24(8):1385-90. doi: 10.1007/s00192-012-2030-6. Epub 2013 Jan 11.
Our purpose was to verify whether extensive dissection toward the sacrospinous ligament (SSL) needed for mesh fixation during anterior compartment repair increases the risk of postoperative voiding difficulties.
A total of 124 patients after anterior compartment mesh repair without simultaneous suburethral sling placement operated on in the period 2005-2012 were enrolled in this retrospective observational study. Patients with previous anti-incontinence surgery with normal urodynamics were not excluded; 30 patients with incomplete data, severe perioperative complications, and urinary retention before and after the surgery were excluded. Urinary retention was defined as post-void residual over 150 ml more than 48 h after permanent catheter removal. The rate of urinary retention after anterior compartment repair by mesh anchored to the SSL from an anterior approach (SSLS group) was compared to that following transobturator mesh repair often combined with SSL fixation from the posterior approach (TOT group).
Of the 94 patients considered for statistical analysis, 62 were from the SLSS group and 32 from the TOT group. The groups were comparable in age (mean 65.5 vs 66.3), body mass index (24.8 vs 25.9), and parity (2.4 vs 2.9). Patients from the SSLS group had higher rates of prior vaginal reconstructive (27 vs 19 %) and anti-incontinence surgery (26 vs 19 %). Postoperative urinary retention was statistically significantly more frequent in the SSLS group compared to the TOT group [(17 (27 %) vs 2 (6.25 %), odds ratio 5.7, 95 % confidence interval 1.2-26.3, p = 0.027]. Hospital discharge with self-catheterization was statistically insignificantly more frequent in the SSLS group [8 % (5) vs 3 % (1)].
Extensive dissection needed for SSL suspension from an anterior approach may lead to more frequent postoperative voiding difficulties. This phenomenon could be explained by more considerable injury to pelvic splanchnic nerves during the dissection. A large prospective study is needed for validation of our results.
我们的目的是验证在前间隔修复术中用于网片固定而向骶棘韧带（SSL）进行广泛解剖是否会增加术后排尿困难的风险。
本回顾性观察研究纳入了2005年至2012年期间接受前间隔网片修复且未同时放置尿道下吊带的124例患者。既往抗尿失禁手术且尿动力学正常的患者未被排除；排除30例数据不完整、围手术期严重并发症以及手术前后存在尿潴留的患者。尿潴留定义为拔除永久导尿管48小时后残余尿量超过150ml。将经前路将网片固定于SSL的前间隔修复术后尿潴留发生率（SSLS组）与常联合经后路进行SSL固定的经闭孔网片修复术后尿潴留发生率（TOT组）进行比较。
在纳入统计分析的94例患者中，62例来自SSLS组，32例来自TOT组。两组在年龄（平均65.5岁对66.3岁）、体重指数（24.8对25.9）和产次（2.4对2.9）方面具有可比性。SSLS组患者既往阴道重建手术（27%对19%）和抗尿失禁手术（26%对19%）的发生率更高。与TOT组相比，SSLS组术后尿潴留的发生在统计学上显著更频繁[17例（27%）对2例（6.25%），优势比5.7，95%置信区间1.2 - 26.3，p = 0.027]。SSLS组出院时带自我导尿的情况在统计学上无显著差异更频繁[8%（5例）对3%（1例）]。
经前路进行SSL悬吊所需的广泛解剖可能导致更频繁的术后排尿困难。这种现象可以通过解剖过程中对盆腔内脏神经造成更严重的损伤来解释。需要进行大型前瞻性研究来验证我们的结果。
