Wang Connie, Zimmern Philippe E, Lemack Gary
The University of Texas Southwestern Medical Center, Dallas, Texas.
Low Urin Tract Symptoms. 2019 Apr;11(2):O103-O110. doi: 10.1111/luts.12226. Epub 2018 Jun 28.
This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings.
Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs.
From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10-161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1-3), and the mean length of initial treatment was 40 min (range 15-79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14-70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas.
TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.
本研究报告了使用钬激光经尿道内镜切除术（TEEH）治疗因合成吊带导致的大型尿道穿孔（UP；定义为累及尿道周长的四分之一或更多）的长期结果。
回顾了接受TEEH治疗大型UP的女性患者病历。TEEH通过将一根365μm的激光光纤穿过置于前列腺钬激光剜除术（HoLEP）鞘内的开放式输尿管导管内进行，以稳定激光光纤。提取的数据包括患者人口统计学资料、临床表现、手术细节、术后功能结果和并发症以及任何二次修复情况。
2011年至2016年，12名女性接受了TEEH治疗。吊带置入与首次TEEH之间的平均间隔时间为47个月（范围10 - 161个月）。吊带类型包括经阴道吊带（n = 2）、经闭孔吊带（n = 4）、微创吊带（n = 4）、Solyx吊带（1例）或未明确说明（n = 1）。TEEH手术的平均次数为1.6次（范围1 - 3次），初始治疗的平均时长为40分钟（范围15 - 79分钟），后续治疗时长<30分钟。平均随访时间为43个月（范围14 - 70个月）。6例患者仅通过TEEH实现了UP的愈合，2例需要多次TEEH治疗。6例患者单独接受了二次阴道网片吊带切除术或联合相关修复，其中包括2例小的远端尿道阴道瘘。
TEEH是一种微创手术，可避免更复杂的初始尿道重建，对于治疗大型UP应予以考虑。对于残留的小型UP或相关下尿路症状可能需要进行二次修复，应相应地对患者进行咨询。
