Lengmang Sunday, Shephard Steven, Datta Avisek, Lozo Svjetlana, Kirschner Carolyn V
Bingham University Teaching Hospital, Jos, Nigeria.
NorthShore University HealthSystem, Evanston, IL, USA.
Int Urogynecol J. 2018 Oct;29(10):1551-1556. doi: 10.1007/s00192-018-3582-x. Epub 2018 Feb 21.
For decades, the pubovesical (PV) sling has been in the armamentarium of the fistula surgeon for treating persistent urinary incontinence after successful fistula closure. We report our early experience with slings, and then also introduce a new "tight" PV sling technique for management of post-fistula urethral leak. Our hypothesis is that performance of tight slings might result in improved continence for women with persistent urinary incontinence after obstetric fistula closure.
Data from 120 patients in whom some type of sling procedure had been performed between 1996 and 2012 were extracted and labeled as "early slings." Beginning in October 2014, more complete data were recorded and a more uniform approach was undertaken in 40 patients. Data were extracted from their charts and recorded as "tight slings." This information was analyzed using Chi-squared analysis.
Tight slings were more successful in patients who had less severe fibrosis and who had a shorter time since initial injury. Thirty percent of women who underwent tight slings had improved continence at follow-up.
Persistent urinary incontinence despite successful surgical closure of obstetrical fistula remains a difficult problem. Tight slings may be warranted in an attempt to avoid urinary diversion.
数十年来，耻骨膀胱（PV）吊带一直是瘘管外科医生治疗瘘管成功闭合后持续性尿失禁的手段之一。我们报告了我们使用吊带的早期经验，随后还介绍了一种新的“紧致”PV吊带技术，用于处理瘘管后尿道渗漏。我们的假设是，对于产科瘘管闭合后仍存在持续性尿失禁的女性，实施紧致吊带可能会改善尿失禁情况。
提取了1996年至2012年间接受某种吊带手术的120例患者的数据，并标记为“早期吊带”。从2014年10月开始，记录了更完整的数据，并对40例患者采用了更统一的方法。从他们的病历中提取数据并记录为“紧致吊带”。使用卡方分析对这些信息进行分析。
紧致吊带在纤维化程度较轻且距初次受伤时间较短的患者中更成功。接受紧致吊带手术的女性中有30%在随访时尿失禁情况有所改善。
尽管产科瘘管手术成功闭合，但持续性尿失禁仍然是一个难题。可能有必要使用紧致吊带以避免尿流改道。
