Milose Jaclyn C, Sharp Kristen M, He Chang, Stoffel John, Clemens J Quentin, Cameron Anne P
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
J Urol. 2015 Mar;193(3):916-20. doi: 10.1016/j.juro.2014.09.038. Epub 2014 Sep 20.
There is no consensus on the management of persistent or recurrent stress incontinence after a failed synthetic mid urethral sling. After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and choose an autologous pubovaginal sling. However, little empirical work has been performed to assess the efficacy.
We performed a retrospective review of 66 women who underwent autologous pubovaginal sling with rectus fascia after 1 or more failed synthetic mid urethral sling from 2007 to 2012.
Mesh removal was performed before autologous pubovaginal sling in 21 patients (31.8%) while 6 (9.1%) had mesh removed simultaneously with autologous pubovaginal sling. Indications for the autologous pubovaginal sling were pure stress urinary incontinence in 16 patients (24.2%) and mixed incontinence in 50 (75.8%), 8 of whom were deemed complex with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months after autologous pubovaginal sling 46 (69.7%) patients reported cure of stress urinary incontinence. Of these patients 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of stress urinary incontinence but had persistent urgency incontinence, and 4 had cure of stress urinary incontinence but experienced do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to cases in which mesh was not removed (p=0.13). Patients with pure stress urinary incontinence were significantly more likely to be cured of all incontinence (62.5%) than those women with preoperative mixed incontinence (30.0%) (p=0.006).
Even after a failed synthetic mid urethral sling, autologous pubovaginal sling is effective and cured stress urinary incontinence in 69.7% of cases.
对于合成材料尿道中段吊带手术失败后持续性或复发性压力性尿失禁的处理，目前尚无共识。在出现网片并发症或吊带失败后，许多女性和外科医生倾向于避免再次使用网片手术，而选择自体耻骨后阴道吊带术。然而，很少有实证研究来评估其疗效。
我们对2007年至2012年间66例因1次或多次合成材料尿道中段吊带手术失败而接受自体耻骨后阴道吊带联合腹直肌筋膜修补术的女性患者进行了回顾性研究。
21例患者（31.8%）在自体耻骨后阴道吊带手术前取出了网片，6例（9.1%）在进行自体耻骨后阴道吊带手术的同时取出了网片。自体耻骨后阴道吊带术的适应证包括单纯性压力性尿失禁16例（24.2%），混合性尿失禁50例（75.8%），其中8例因既往有尿道憩室或尿道阴道瘘/尿道网片侵蚀而被视为复杂性病例。自体耻骨后阴道吊带术后平均14.5个月时，46例（69.7%）患者报告压力性尿失禁治愈。其中25例（37.9%）完全治愈，无压力性或急迫性尿失禁；17例压力性尿失禁治愈，但仍有持续性急迫性尿失禁；4例压力性尿失禁治愈，但出现了新发的急迫性尿失禁。与未取出网片的病例相比，需要进行网片切除并不能预测更差预后（p=0.13）。单纯性压力性尿失禁患者完全治愈所有尿失禁的可能性（62.5%）显著高于术前为混合性尿失禁的女性患者（30.0%）（p=0.006）。
即使在合成材料尿道中段吊带手术失败后，自体耻骨后阴道吊带术仍然有效，69.7%的病例中压力性尿失禁得以治愈。
