Weill Medical College of Cornell University and Urocenter of New York, New York, New York.
J Urol. 2013 Oct;190(4):1281-6. doi: 10.1016/j.juro.2013.03.044. Epub 2013 Mar 19.
We report our experience with the diagnosis and treatment of refractory synthetic sling complications in women.
This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.
A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct sling complications. Original sling composition was type 1 mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy and urinary diversion, and enterocystoplasty. Median followup was 2 years (range 0.25 to 12, mean 3). Overall a successful outcome was achieved in 34 of 47 patients (72%) after the first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 patients with treatment failure 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion and cystectomy (1), partial cystectomy and augmentation cystoplasty (1), biological sling and sinus tract excision (1), and vaginal mesh excision (1).
Success after the initial failure of mesh sling complications repair is possible but multiple surgeries may be required. Each symptom should be addressed separately.
我们报告了在女性中治疗难治性合成吊带并发症的经验。
这是一项对治疗失败的网片吊带并发症的连续女性患者的回顾性研究。手术前后，患者完成了经过验证的问卷和排尿日记，并进行了尿流率检查、残余尿测量、垫试验、膀胱尿道镜检查和影像尿动力学研究。治疗是个体化的，并将结果分为两组情况和症状。通过患者总体改善印象评分（成功为 1 分，改善为 2-3 分，失败为 4-7 分）来评估结果。
共有 47 名 35 至 83 岁（平均 60 岁）的女性接受了至少 1 次手术（范围 1 至 4 次）来纠正吊带并发症。最初的吊带材料为 36 例 1 型网片，11 例 2 型和 3 型。手术程序包括吊带切开、吊带切除、尿道松解、尿道重建、输尿管膀胱切开术、膀胱切除术和尿流改道，以及肠膀胱成形术。中位随访时间为 2 年（范围 0.25 至 12 年，平均 3 年）。首次挽救性手术后，47 例患者中有 34 例（72%）获得了成功的结果。每个患者的失败原因都是多方面的。在 13 例治疗失败的患者中，9 例随后进行了 14 次手术。5 例（56%）患者在接受了经皮耻骨上膀胱造瘘术（1 例）、经皮耻骨上膀胱造瘘术和膀胱切除术（1 例）、部分膀胱切除术和膀胱扩大术（1 例）、生物吊带和窦道切除术（1 例）以及阴道网片切除术（1 例）后取得了成功/改善。
在网片吊带并发症修复治疗失败后获得成功是可能的，但可能需要多次手术。每个症状都应单独处理。
