Department of Urology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
Int Neurourol J. 2013 Mar;17(1):18-23. doi: 10.5213/inj.2013.17.1.18. Epub 2013 Mar 31.
Despite reports of persistent stress urinary incontinence (SUI) in patients after the midurethral sling (MUS) procedure, there is no widely accepted definition or cause of the condition. In many cases, the mesh implanted in the previous MUS procedure has been found to have migrated proximally. The aim of this study was to evaluate the efficacy of the modified distal urethral polypropylene sling, or canal transobturator tape (TOT), procedure for persistent SUI after a conventional MUS procedure on the assumption that persistent SUI after MUS is due to the location of the sling.
From January 2008 to April 2012, 31 female patients who underwent the canal TOT procedure presented with incontinence or lower urinary tract symptoms (LUTS) were included in this study. We identified patients who had been operated on by use of the conventional MUS procedure at other medical facilities, whose Valsalva leak pressure point was less than 120 cm-H2O by urodynamic study, and who were also diagnosed with persistent SUI. If vaginal or urethral mesh exposure was concomitant with persistent SUI, the mesh was removed completely or in part. Surgical procedures for canal TOT were identical to the original TOT procedures, except in the number and location of the vaginal incisions. Incontinence Impact Questionnaire-Short Form (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) scores were assessed preoperatively and at 3 months postoperatively.
There were no intraoperative or postoperative complications. Twenty-eight patients (90.3%) showed improvement in incontinence or other LUTS. Postoperative scores of the IIQ-7 (0.65±0.48) and UDI-6 (3.48±2.28) were significantly improved compared with preoperative scores (1.26±0.58 and 7.52±4.30, respectively; P<0.05).
Improper sling location is one of the major causes of persistent SUI after the conventional MUS procedure. Our results demonstrate that canal TOT may be an alternative method in the treatment of persistent SUI after the conventional MUS procedure.
尽管有报道称，在接受尿道中段吊带（MUS）手术后的患者中存在持续性压力性尿失禁（SUI），但目前仍没有广泛接受的关于该病症的定义或病因。在许多情况下，先前的 MUS 手术中植入的网片已被发现向上迁移。本研究旨在评估改良后的远端尿道聚丙烯吊带（或经阴道隧道吊带，TOT）治疗常规 MUS 术后持续性 SUI 的疗效，假设 MUS 术后持续性 SUI 是由于吊带位置所致。
2008 年 1 月至 2012 年 4 月，对 31 名因持续性 SUI 接受经阴道隧道 TOT 手术的女性患者进行了研究。我们选择了曾在其他医疗机构接受常规 MUS 手术，尿动力学检查时的 Valsalva 漏尿点压力小于 120cmH2O，并诊断为持续性 SUI 的患者。如果阴道或尿道网片暴露与持续性 SUI 并存，则将网片完全或部分切除。经阴道隧道 TOT 手术与原始 TOT 手术相同，仅阴道切口的数量和位置不同。术前和术后 3 个月采用尿失禁影响问卷-短表（IIQ-7）和泌尿生殖窘迫问卷-短表（UDI-6）评估。
无术中或术后并发症。28 例（90.3%）患者的失禁或其他下尿路症状得到改善。术后 IIQ-7（0.65±0.48）和 UDI-6（3.48±2.28）评分均显著优于术前（1.26±0.58 和 7.52±4.30；P<0.05）。
吊带位置不当是常规 MUS 术后持续性 SUI 的主要原因之一。我们的结果表明，经阴道隧道 TOT 可能是治疗常规 MUS 术后持续性 SUI 的一种替代方法。
