Sergouniotis Fotios, Jarlshammar Björn, Larsson Per-Göran
Fotios Sergouniotis, Per-Göran Larsson, Department of Obstetrics and Gynecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
World J Nephrol. 2015 Jul 6;4(3):396-405. doi: 10.5527/wjn.v4.i3.396.
To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.
This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset (< 12 mo) or late onset (> 12 mo) according to when they were first reported.
Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence (7/9 patients), urinary retention/voiding dysfunction (4/9 patients), urethritis (4/9 patients), relapse of stress-incontinence (3/9 patients), recurrent urinary tract infections (5/9 patients), and hematuria (1/9 patient). In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures.
Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.
分析无张力阴道吊带手术后尿道并发症的临床特征、诊断方法及手术治疗。
本研究对9例接受尿道中段吊带手术后出现尿道并发症的患者进行回顾性分析。这些患者于1999年至2012年期间在瑞典西南部的三家不同地区医院接受了手术。报告了从吊带置入到诊断的时间、危险因素、临床特征、诊断、手术治疗及功能结局。根据首次报告症状的时间，将其描述为早发（<12个月）或晚发（>12个月）。
共检测到8例尿道侵蚀和1例膀胱颈侵蚀。侵蚀诊断的平均间隔时间为3个月至年。最常见的症状包括新发尿急伴或不伴尿失禁（7/9例患者）、尿潴留/排尿功能障碍（4/9例患者）、尿道炎（4/9例患者）、压力性尿失禁复发（3/9例患者）、复发性尿路感染（5/9例患者）及血尿（1/9例患者）。大多数情况下，排尿功能障碍和尿道炎在术后早期出现。多数病例采用的手术治疗方法是经尿道切除网片的尿道内部分。切除尿道内网片使5/7例尿急患者的尿急症状得到改善或完全治愈。4例患者再次接受了新的压力性尿失禁手术，1例采用腹腔镜Burch手术，3例采用耻骨后无张力阴道吊带手术。
出现新发尿急和压力性尿失禁复发时应怀疑尿道并发症。推荐的治疗方法是经尿道切除尿道内网片。
