Forzini T, Viart L, Alezra E, Saint F
Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France.
Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire d'anatomie et d'organogénèse, UFR de médecine d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France.
Prog Urol. 2015 Apr;25(5):240-8. doi: 10.1016/j.purol.2014.12.007. Epub 2015 Jan 20.
Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE).
Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape).
Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%).
The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.
评估中段尿道吊带（MUS）手术后糜烂性并发症的诊断和治疗管理：阴道糜烂（VE）、膀胱（BE）和尿道（UE）。
对2002年1月至2013年1月接受手术治疗的患者队列进行回顾性单中心研究，这些患者因MUS（无张力阴道吊带术[TVT]或经闭孔吊带术[TOT]）的糜烂性并发症而接受支持治疗。
16例患者被诊断为糜烂性并发症：7例VE、6例BE和3例UE。86%（n = 6/7）患有VE的患者出现性交困难和阴道分泌物。对于阴道糜烂病例，系统地采用经阴道途径进行保守治疗。取出材料后，100%的性交困难得到纠正。57%（n = 4/7）的患者术后保持了尿失禁。尿路感染是BE患者的主要症状。66%（n = 2/3）患有UE的患者出现严重排尿困难。77%（n = 7/9）患有BE或UE的患者接受了内镜治疗作为一线治疗。42%（n = 3/7）接受内镜一线治疗的患者因MUS再次暴露而需要进行二次手术。9例患者中有3例在一线治疗后出现尿失禁复发（33%）。
对于VE病例，经阴道取出暴露的装置可系统地纠正症状，约60%的患者保持尿失禁。对于BE或UE病例，一线治疗中的内镜治疗很少能彻底解决问题（42%），且30%的病例出现尿失禁复发。
