Department of Urology, Western Health, University of Melbourne, Melbourne, Australia.
Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia.
Neurourol Urodyn. 2019 Jun;38(5):1409-1416. doi: 10.1002/nau.24000. Epub 2019 Apr 18.
To determine the optimal degree of pubovaginal slings (PVS) tension, measured by lax sling dimensions to minimize the risk of urinary retention.
This prospective study analyzed female patients undergoing PVS for stress urinary incontinence (SUI) by two surgeons over 24 months from January 2016. Intra-operative measurements of lax sling dimensions tented over rectus fascia were recorded. Logistic regression was used to analyse the likelihood of urinary retention (more than 3 months of intermittent self-catheterisation (ISC) or surgical revision) for given PVS dimensions. The secondary analysis assessed for an association between PVS measurements and persistent SUI.
Fifty-one patients were recruited with a median age of 53 (34-78) and follow-up of 11 (3-20) months. All but one patient reported improvement of SUI. Ten (19.6%) patients developed postoperative urinary retention. Five (9.8%) resolved after a temporary period of ISC. The other five (9.8%) required ongoing ISC or sling division. A strong association existed between short sling height and prolonged urinary retention (P = 0.00). Receiver operating characteristic (ROC) curve analysis showed a sling height of 40 mm had a sensitivity of 100% and specificity of 51% for retentive complications (area under curve [AUC] = 0.90). Lax sling height up to 60 mm was not associated with persistent SUI.
Stretching the sling suspension sutures at least 40 mm above the rectus fascia was associated with a lower risk of urinary retention than less than 40 mm. This simple technique would appear to be worth evaluating in a larger sample. A looser sling did not compromise the cure of SUI at a mean follow-up of 11 months.
确定通过松弛吊带尺寸测量的最佳耻骨阴道吊带（PVS）张力程度，以最大程度降低尿潴留风险。
本前瞻性研究分析了 2016 年 1 月至 24 个月期间由两位外科医生对 51 例因压力性尿失禁（SUI）接受 PVS 的女性患者。记录松弛吊带在腹直肌筋膜上悬垂时的松弛吊带尺寸的术中测量值。使用逻辑回归分析特定 PVS 尺寸下发生尿潴留（超过 3 个月间歇性自我导尿（ISC）或手术修正）的可能性。二次分析评估了 PVS 测量值与持续性 SUI 之间的相关性。
51 例患者入组，中位年龄为 53 岁（34-78 岁），随访 11 个月（3-20 个月）。除 1 例患者外，所有患者均报告 SUI 改善。10 例（19.6%）患者发生术后尿潴留。5 例（9.8%）在暂时接受 ISC 后得到缓解。另外 5 例（9.8%）需要持续进行 ISC 或吊带切开。吊带高度较短与尿潴留时间延长之间存在很强的相关性（P=0.00）。受试者工作特征（ROC）曲线分析显示，吊带高度为 40mm 时，对留置并发症的敏感性为 100%，特异性为 51%（曲线下面积[AUC]为 0.90）。松弛吊带高度高达 60mm 与持续性 SUI 无关。
与小于 40mm 相比，将吊带悬挂缝线至少拉伸 40mm 以上与尿潴留风险降低相关。这种简单的技术似乎值得在更大的样本中进行评估。在平均 11 个月的随访中，更宽松的吊带并未影响 SUI 的治愈率。
