Bogusiewicz Michał, Monist Marta, Stankiewicz Aleksandra, Woźniak Magdalena, Wieczorek Andrzej Paweł, Rechberger Tomasz
2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland.
Ginekol Pol. 2013 May;84(5):334-8. doi: 10.17772/gp/1585.
The high-pressure zone of the urethra (HPZ), which is crucial for the continence mechanism, extends between the point of the maximum urethral closure pressure and the urethral knee, and has been calculated to lie between 53% and 72% of the functional urethral length. According to recent studies the best results of suburethral slings are achieved when tapes are positioned under this zone. The aim of the study was to determine the location of tapes relative to the urethral length in patients seeking help due to recurrent stress urinary incontinence (SUI) following sling procedures.
The study group comprised 61 patients suffering from recurrent SUI following suburethral slings performed from 6 months to 5 years earlier Forty-nine (80.3%) women were initially treated with a transobturator sling and 12 (19.7%) with a retropubic procedure. Twenty patients had the original sling performed at our department whereas, the other 41 in other institutions. The position of the tapes was determined at the sagittal plane by 3-D transvaginal ultrasound using a linear transducer The length of the urethra was measured from the bladder neck to the external urethral meatus following the urethral lumen, taking into account its curve. The position of the tapes relative to the percentage of the urethral length was calculated assuming the bladder neck as the proximal end of the urethra. The reference point was set at the midpoint on the tape.
Only 13 (21.3%) patients had tapes positioned at 50%-75% of the urethral length. In 45 (73.8%) of women examined the tapes were found under proximal half of the urethra and in 3 (4.9%) distally to the 75% of the urethral length.
In most patients in whom slings procedures proved unsuccessful the tapes are located under the proximal half of the urethra, that is outside the HPZ The position of a.tape outside the HPZ may be considered as a cause of suburethral sling failure.
尿道高压区（HPZ）对控尿机制至关重要，它在尿道最大闭合压点与尿道膝部之间延伸，经计算其位于功能性尿道长度的53%至72%之间。根据最近的研究，当吊带置于该区域下方时，耻骨后吊带术能取得最佳效果。本研究的目的是确定因吊带术后复发性压力性尿失禁（SUI）前来寻求帮助的患者中，吊带相对于尿道长度的位置。
研究组包括61例患者，这些患者在6个月至5年前接受了耻骨后吊带术，术后出现复发性SUI。49例（80.3%）女性最初接受了经闭孔吊带术，12例（19.7%）接受了耻骨后手术。20例患者在我们科室进行了初次吊带手术，其余41例在其他机构进行。使用线性换能器通过三维经阴道超声在矢状面确定吊带的位置。沿着尿道管腔从膀胱颈测量至尿道外口来测量尿道长度，并考虑其弯曲度。假设膀胱颈为尿道近端，计算吊带相对于尿道长度百分比的位置。参考点设定在吊带上的中点。
只有13例（21.3%）患者的吊带位于尿道长度的50%至75%之间。在45例（73.8%）接受检查的女性中，发现吊带位于尿道近端一半以下，3例（4.9%）位于尿道长度的75%以上。
在大多数吊带手术失败的患者中，吊带位于尿道近端一半以下，即位于HPZ之外。吊带位于HPZ之外的位置可能被视为耻骨后吊带失败的一个原因。
