Schöller Dorit, Brucker Sara, Reisenauer Christl
Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.
Geburtshilfe Frauenheilkd. 2018 Oct;78(10):991-998. doi: 10.1055/a-0704-3461. Epub 2018 Oct 19.
The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 - 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.
耻骨后（TVT）或经闭孔（TOT）无张力尿道下阴道吊带置入术后或医源性经尿道吊带意外移位后发生的尿道吊带侵蚀并发症，可导致尿道阴道瘘或膀胱阴道瘘的形成。本研究的目的是评估此类罕见并发症的处理方法。对2011年6月至2018年2月在图宾根大学妇科接受TVT/TOT置入术后尿道病变或尿道阴道瘘形成治疗的14例患者进行回顾性分析。作为手术治疗，57.1%（n = 8）的病例采用大阴唇Martius皮瓣进行阴道瘘修补，21.4%（n = 3）采用阴道旋转皮瓣。21.4%（n = 3）的病例在经尿道切除吊带或吊带侵蚀后，仅进行尿道阴道缝合重建。50%（n = 7）的患者术后持续控尿，无需进一步治疗。28.6%（n = 4）的患者存在持续性压力性尿失禁，21.4%（n = 3）的患者存在混合性尿失禁。7例持续性尿失禁患者中有6例在术后平均8.8个月（5 - 13个月）接受了耻骨后无张力尿道下吊带（TVT）的再次置入，所有患者均未出现并发症，控尿效果满意。3例混合性尿失禁且伴有持续性尿急的患者额外接受了抗胆碱能药物治疗。在研究期间，未出现长期并发症，尤其是没有复发性瘘。TVT/TOT置入术后尿道侵蚀、经尿道吊带移位或尿道阴道瘘形成等罕见但相关的并发症可通过阴道手术成功处理。术后持续性尿失禁且在伤口充分愈合后需要分两期重复置入TVT的情况，术前必须明确。
