Brennand Erin A, Tang Selphee, Birch Colin, Robert Magali, Kim-Fine Shunaha
Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
Int Urogynecol J. 2017 Oct;28(10):1515-1526. doi: 10.1007/s00192-017-3302-y. Epub 2017 Mar 11.
Early voiding dysfunction (EVD) with urinary retention (UR) is a complication of midurethral sling (MUS) surgery. Management is not standardized. Our objective was to characterize management approaches at our center, and report outcomes including resolution of UR, persistent voiding dysfunction, and recurrent stress urinary incontinence (SUI).
All women requiring catheterization for ≥7 days after MUS surgery during the period March 2014 to 2016 were eligible for inclusion in this prospective study. The management plan for each patient was decided jointly by the surgeon and the patient. Questionnaires regarding urinary symptoms were administered at enrollment, and 3 and 6 months after surgery. The timing and type of any surgical intervention were recorded.
During the 2-year period, 31 women experienced EVD for ≥7 days after MUS surgery. At 6 months, complete data were available for 30 women (97%). Two management approaches were identified: "early mobilization" to loosen the MUS intact (in 10 patients), and continued catheterization with delayed sling lysis as needed (in 21 patients). In eight of the ten women in the early mobilization group, UR resolved after one intervention. Two required a second mobilization. For all women in this group, UR resolved after one or two procedures. In 11 of the 21 women in the continued catheterization group UR resolved without intervention. The other ten women in the continued catheterization group opted for sling lysis ≤6 months after MUS surgery. None of the women in the mobilization group reported SUI at 6 months in contrast to 9 of 20 (45%) in the planned continued catheterization group (p = 0.029). Seven of the nine women experiencing recurrent SUI had undergone sling lysis.
Patients experiencing EVD after MUS surgery can be informed that UR will resolve in 50% with continued catheterization. Mobilization should be an option for those not comfortable with prolonged catheterization. Early intervention by mobilization may be associated with a lower risk of recurrent SUI, compared to continued catheterization and delayed sling lysis.
伴有尿潴留（UR）的早期排尿功能障碍（EVD）是经尿道中段吊带术（MUS）的一种并发症。其治疗方法尚未标准化。我们的目的是描述我们中心的治疗方法，并报告相关结果，包括尿潴留的解决情况、持续性排尿功能障碍以及复发性压力性尿失禁（SUI）。
2014年3月至2016年期间，所有在MUS手术后需要导尿≥7天的女性均符合纳入本前瞻性研究的条件。每位患者的治疗方案由外科医生和患者共同决定。在入组时以及术后3个月和6个月进行关于泌尿系统症状的问卷调查。记录任何手术干预的时间和类型。
在这2年期间，31名女性在MUS手术后出现EVD≥7天。在6个月时，30名女性（97%）有完整数据。确定了两种治疗方法：“早期活动”以完整松解MUS（10例患者），以及根据需要持续导尿并延迟吊带松解（21例患者）。早期活动组的10名女性中有8名在一次干预后尿潴留得到解决。2名需要第二次活动。该组所有女性在一或两次操作后尿潴留均得到解决。持续导尿组的21名女性中有11名未经干预尿潴留即得到解决。持续导尿组的其他10名女性选择在MUS手术后≤6个月进行吊带松解。活动组无一例女性在6个月时报告有SUI，而计划持续导尿组的20名中有9名（45%）报告有SUI（p = 0.029）。9名复发性SUI女性中有7名接受了吊带松解。
可以告知MUS手术后出现EVD的患者，持续导尿的情况下50%的患者尿潴留会得到解决。对于不适应长时间导尿的患者，活动应是一种选择。与持续导尿和延迟吊带松解相比，早期通过活动进行干预可能与复发性SUI的风险较低相关。
