Colhoun Andrew, Rapp David E
From the *Virginia Commonwealth University School of Medicine; and †Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Richmond, VA.
Female Pelvic Med Reconstr Surg. 2016 Jul-Aug;22(4):272-5. doi: 10.1097/SPV.0000000000000273.
The literature lacks long-term evaluation of outcomes after repair of transurethral midurethral sling (MUS) perforation.
We prospectively followed 5 patients undergoing repair of urethral perforation (International Continence Society-International Urogynecological Association classification 4B) after MUS (mean follow-up, 54 months). Outcomes assessment was composed of validated measures of urinary (International Consultation on Incontinence Questionnaire [ICIQ]-Female Lower Urinary Tract Symptoms), vaginal (ICIQ-Vaginal Symptoms), and quality of life (Incontinence Impact Questionnaire, Short Form) symptoms.
Five patients underwent MUS (4 transobturator, 1 retropubic) with a mean of 41 months before referral. Primary referring complaints composed of hematuria (2), weak stream (2), and urgency (1). All but 1 patient reported transient urinary retention requiring catheterization after initial sling placement. Each patient underwent transvaginal sling excision and repair of urethral injury. Four of 5 patients experienced persistent postoperative stress urinary incontinence. Before final assessment, further treatment included observation, physical therapy, and autologous fascial sling in 1, 2, and 2 patients, respectively. ICIQ-Female Lower Urinary Tract Symptoms, ICIQ-Vaginal Symptoms, and Incontinence Impact Questionnaire, Short Form, assessment failed to demonstrate statistically significant improvements in comparison of baseline and multiple time point (6-week, 12-month, 54-month) assessments during long-term follow-up (P > 0.05).
Urethral perforation represents a significant complication after MUS placement. Many patients continue to have incontinence despite the use of physical therapy/salvage sling placement. Furthermore, subjective outcomes and quality of life do not seem to improve over time. Because of the rarity of urethral perforation, our small series is notable given the absence of reported data that include prospective, long-term follow-up with validated questionnaire evaluation.
目前文献中缺乏对经尿道中段尿道吊带术（MUS）穿孔修复术后结局的长期评估。
我们前瞻性地随访了5例在接受MUS后进行尿道穿孔修复的患者（国际尿控协会-国际妇科泌尿协会分类为4B级）（平均随访时间为54个月）。结局评估包括经过验证的泌尿系统症状（国际尿失禁咨询委员会女性下尿路症状问卷[ICIQ-Female Lower Urinary Tract Symptoms]）、阴道症状（ICIQ-阴道症状问卷）和生活质量（尿失禁影响问卷简表）的测量。
5例患者接受了MUS（4例经闭孔，1例耻骨后），转诊前平均时间为41个月。主要转诊主诉包括血尿（2例）、尿流无力（2例）和尿急（1例）。除1例患者外，所有患者在初次放置吊带后均出现短暂性尿潴留，需要导尿。每位患者均接受了经阴道吊带切除术及尿道损伤修复术。5例患者中有4例术后仍存在持续性压力性尿失禁。在最终评估前，进一步的治疗分别包括观察、物理治疗以及1例、2例和2例患者接受自体筋膜吊带术。在长期随访期间，与基线和多个时间点（6周、12个月、54个月）评估相比，ICIQ-女性下尿路症状问卷、ICIQ-阴道症状问卷和尿失禁影响问卷简表评估均未显示出统计学上的显著改善（P>0.05）。
尿道穿孔是MUS放置后的一种严重并发症。尽管采用了物理治疗/补救性吊带放置术，许多患者仍存在尿失禁。此外，主观结局和生活质量似乎并未随时间改善。由于尿道穿孔罕见，鉴于缺乏包括前瞻性、长期随访及经过验证的问卷评估在内的报道数据，我们的小样本系列具有一定意义。
