Kavanagh Alex, Sanaee May, Carlson Kevin V, Bailly Gregory G
Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada.
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC; Canada.
Can Urol Assoc J. 2017 Jun;11(6Suppl2):S143-S146. doi: 10.5489/cuaj.4610.
Surgical failure rates after midurethral sling (MUS) procedures are variable and range from approximately 8-57% at five years of followup. The disparity in long-term failure rates is explained by a lack of long-term followup and lack of a clear definition of what constitutes failure. A recent Cochrane review illustrates that no high-quality data exists to recommend or refute any of the different management strategies for recurrent or persistent stress urinary incontinence (SUI) after failed MUS surgery. Clinical evaluation requires a complete history, physical examination, and establishment of patient goals. Conservative treatment measures include pelvic floor physiotherapy, incontinence pessary dish, commercially available devices (Uresta, Impressa), or medical therapy. Minimally invasive therapies include periurethral bulking agents (bladder neck injections) and sling plication. Surgical options include repeat MUS with or without mesh removal, salvage autologous fascial sling or Burch colposuspension, or salvage artificial urinary sphincter insertion. In this paper, we present the available evidence to support each of these approaches and include the management strategy used by our review panel for patients that present with SUI after failed midurethral sling.
经尿道中段吊带术（MUS）后的手术失败率各不相同，在随访五年时约为8%-57%。长期失败率存在差异的原因是缺乏长期随访以及对失败的构成没有明确的定义。最近一项Cochrane综述表明，没有高质量的数据来推荐或反驳MUS手术失败后复发性或持续性压力性尿失禁（SUI）的任何不同管理策略。临床评估需要完整的病史、体格检查以及确立患者目标。保守治疗措施包括盆底物理治疗、失禁子宫托盘、市售装置（Uresta、Impressa）或药物治疗。微创治疗包括尿道周围填充剂（膀胱颈注射）和吊带折叠术。手术选择包括有或没有移除网片的重复MUS、挽救性自体筋膜吊带或Burch阴道悬吊术，或挽救性人工尿道括约肌植入术。在本文中，我们展示了支持这些方法的现有证据，并包括我们的综述小组对经尿道中段吊带术失败后出现SUI的患者所采用的管理策略。
