Fabian George, Kociszewski Jacek, Kuszka Andrzej, Fabian Margarethe, Grothey Susane, Zwierzchowska Aneta, Majkusiak Wojciech, Barcz Ewa
Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, Hagen, Gemany.
I Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
Arch Med Sci. 2015 Oct 12;11(5):982-8. doi: 10.5114/aoms.2014.42305.
Sling techniques are the method of choice in stress urinary incontinence management, despite the high rates of complications leading sometimes to the necessity of re-operation, and the tape transection and resection are of the greatest importance. The study was aimed at analyzing the indications, technique and effects of transvaginal tape excision.
A retrospective study including 100 patients who underwent surgical removal of the sub-urethral sling in Evangelisches Krankenhaus Hagen-Haspe was conducted. The analyzed measures were: sling type, onset of symptoms, rates of particular complications, safety and outcome of the operative procedure.
Most complications occurred in the first 2 years after surgery. The most common indications for re-operation were: overactive bladder (OAB) (64%), persistent stress urinary incontinence (SUI) (59%), pain (40%), urinary retention (40%), and erosion (29%). Some of the complications co-existed (i.e. vaginal erosion with postoperative pain, infections with urinary retention). During the procedure 1 bladder was injured and 1 patient had a hematoma. In women with OAB, 24-hour frequency decreased from 13.3 to 8.5 (p < 0.001), the mean voiding volume increased from 131.7 to 216.4 ml (p < 0.001), and nocturia increased from 3.28 to 1.19 (p < 0.001). Intensity of urgency decreased from 8.78 to 0.92 in the 10-point visual score (p < 0.001). Pain and urinary retention resolved in 39 out of 40 patients (p < 0.0001). The rate of SUI increased from 59% to 83% (p < 0.001).
Sling removal is safe and associated with a minimal rate of complications. Removing the tape causes resolution of most of the complications, but SUI recurs or worsens.
吊带技术是压力性尿失禁治疗的首选方法，尽管并发症发生率较高，有时需要再次手术，而吊带的切断和切除至关重要。本研究旨在分析经阴道吊带切除的适应症、技术及效果。
对哈根 - 哈斯佩福音医院100例行尿道下吊带手术切除的患者进行回顾性研究。分析的指标包括：吊带类型、症状出现时间、特定并发症发生率、手术安全性及结果。
大多数并发症发生在术后头两年。再次手术最常见的适应症为：膀胱过度活动症（OAB）（64%）、持续性压力性尿失禁（SUI）（59%）、疼痛（40%）、尿潴留（40%）和侵蚀（29%）。部分并发症同时存在（如阴道侵蚀伴术后疼痛、感染伴尿潴留）。手术过程中1例膀胱受损，1例患者出现血肿。对于患有OAB的女性，24小时排尿次数从13.3次降至8.5次（p < 0.001），平均排尿量从131.7毫升增至216.4毫升（p < 0.001），夜尿次数从3.28次增至1.19次（p < 0.001）。在10分视觉评分中，尿急强度从8.78降至0.92（p < 0.001）。40例患者中有39例疼痛和尿潴留症状缓解（p < 0.0001）。SUI发生率从59%增至83%（p < 0.001）。
吊带切除安全，并发症发生率极低。切除吊带可使大多数并发症得到缓解，但SUI会复发或加重。
