Thubert T, Ait Hammou-Sadi F, Faivre E, Trichot C, Fernandez H, Deffieux X
Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
Prog Urol. 2013 Apr;23(4):262-9. doi: 10.1016/j.purol.2013.01.020. Epub 2013 Mar 13.
There are few data concerning the results of the treatment of recurrent stress urinary incontinence (SUI) after redo mid-urethral sling (MUS) procedure.
Retrospective study concerning 34 patients presenting with recurrent SUI following the placement of a first MUS procedure and who have undergone a second MUS procedure. Results were evaluated objectively (cough stress test) and subjectively using international consultation on incontinence questionnaire-short form (ICIQ-SF).
The surgical technique for the placement of the first MUS was a retropubic approach in seven (20.5%) cases and a transobturator approach in 27 (79.5%) cases. Concerning the redo MUS procedure, a retropubic procedure was performed in 25 (73.5%) patients and a transobturator procedure in nine (26.5%) patients. Among the 34 patients, 32 (94%) were re-examined at 2 months follow-up, and contacted through telephone after 1-year follow-up. Post-operatively, the cough stress test revealed no urine leakage in 27/32 (84%) patients. Median follow-up was 15.5 months. ICIQ-SF score was 0 (complete continence) in 19/32 (59%) patients; between 4 and 12 in 11/32 (34%) and between 13 and 20 in 2/32 (6%) patients. A bladder injury was diagnosed during the surgical procedure in two patients. A reintervention was required in 2/34 (5%) patients because of postoperative urinary retention or bladder outlet obstruction. A partial sling resection was required in 2/34 (5%) patients because of vaginal exposure of the synthetic sling.
In this study, redo MUS procedure was associated with good functional results despite a high rate of complications.
关于经尿道中段吊带术（MUS）术后复发性压力性尿失禁（SUI）的治疗结果，相关数据较少。
对34例在首次MUS手术后出现复发性SUI且接受了第二次MUS手术的患者进行回顾性研究。结果通过客观（咳嗽压力试验）和主观（使用国际尿失禁咨询问卷简表[ICIQ-SF]）进行评估。
首次MUS手术的放置技术中，耻骨后途径7例（20.5%），经闭孔途径27例（79.5%）。关于再次进行MUS手术，耻骨后手术25例（73.5%），经闭孔手术9例（26.5%）。34例患者中，32例（94%）在2个月随访时接受复查，1年随访时通过电话联系。术后，咳嗽压力试验显示27/32（84%）患者无尿液漏出。中位随访时间为15.5个月。ICIQ-SF评分在19/32（59%）患者中为0（完全控尿）；11/32（34%）患者在4至12分之间，2/32（6%）患者在13至20分之间。手术过程中诊断出2例膀胱损伤。2/34（5%）患者因术后尿潴留或膀胱出口梗阻需要再次干预。2/34（5%）患者因合成吊带暴露于阴道需要进行部分吊带切除术。
在本研究中，尽管并发症发生率较高，但再次进行MUS手术仍取得了良好的功能结果。
