Miller Adam R, Linder Brian J, Lightner Deborah J
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Int Urogynecol J. 2018 Sep;29(9):1403-1405. doi: 10.1007/s00192-018-3643-1. Epub 2018 Apr 11.
Autologous pubovaginal sling placement remains a treatment option in index patients, given high, long-term success rates. This video reviews the technical considerations for performing an autologous rectus fascia sling.
The patient is a 47-year-old woman with stress urinary incontinence (SUI) refractory to conservative management. First, a 10-cm rectus fascial segment is harvested and prepped with placement of nonabsorbable stay sutures for later sling passage. Then, an inverted U-shaped incision is made in the anterior vaginal wall based on the bladder neck, and perforation of the endopelvic fascia is performed. Following passage of the sling in the retropubic space, it is secured to periurethral tissue. Cystoscopy is then used to evaluate for bladder perforation and to confirm sling tensioning.
The patient was discharged on the same day of surgery with a suprapubic tube in place, which was removed on postoperative day 7 after passing a capping trial. At 6 weeks' follow-up, the patient had complete resolution of SUI, with no de novo urgency symptoms, and could empty her bladder to completion.
Autologous pubovaginal sling placement remains an effective treatment option for the management of female SUI. This video highlights important technical considerations for this procedure.
鉴于自体耻骨阴道吊带置入术具有较高的长期成功率，仍是初次治疗患者的一种治疗选择。本视频回顾了进行自体腹直肌筋膜吊带术的技术要点。
患者为一名47岁女性，压力性尿失禁（SUI）经保守治疗无效。首先，获取一段10厘米的腹直肌筋膜，用不可吸收的定位缝线进行准备，以便随后穿过吊带。然后，在膀胱颈水平的阴道前壁做一个倒U形切口，并穿透盆内筋膜。在耻骨后间隙穿过吊带后，将其固定于尿道周围组织。然后使用膀胱镜检查评估是否存在膀胱穿孔并确认吊带张力。
患者在手术当天带着耻骨上导尿管出院，在进行夹管试验后于术后第7天拔除导尿管。在6周的随访中，患者的SUI完全缓解，无新发尿急症状，且能完全排空膀胱。
自体耻骨阴道吊带置入术仍然是治疗女性SUI的一种有效治疗选择。本视频强调了该手术的重要技术要点。
