Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Urology. 2020 Sep;143:266. doi: 10.1016/j.urology.2020.05.031. Epub 2020 Jun 2.
Autologous pubovaginal sling is a surgical option for patients with stress urinary incontinence (SUI), either as primary treatment, or in those who have failed synthetic sling placement. It is also favorable for patients at high risk of mesh erosion, for example, in those who are immunocompromised or postradiation. This video reviews the technical considerations in performing an autologous pubovaginal sling fashioned from rectus fascia in an immunocompromised patient with multiple previous abdominal surgeries.
The patient is a 63-year-old woman with SUI refractory to conservative management, with a background of Behcet's disease on long-term steroids. First, a 12 × 2 cm rectus sheath graft was harvested through a Pfannenstiel incision. Stay sutures were placed to aid in subsequent sling placement. A vertical incision was made in the anterior vaginal wall after hydro-dissection with lignocaine/adrenaline solution and the plane was developed with a combination of blunt and sharp dissection. The trocars with the attached fascial sling were passed retropubically. Sling tensioning was assessed with a Q-tip test. An inadvertent bladder perforation was noted during the passage of the left trocar on intraoperative cystoscopy, which was managed conservatively with urinary catheterization for one week postoperatively.
The patient was discharged well on postoperative day 2 and underwent a successful trial off catheter on postoperative day 7. At 1-month follow-up, the patient reported complete resolution of her SUI with no de-novo urgency or voiding dysfunction.
Autologous pubovaginal slings are an effective treatment option for SUI with minimal morbidity especially in patients with high risk of mesh erosion.
自体耻骨阴道吊带是治疗压力性尿失禁（SUI）的一种手术选择，可作为主要治疗方法，也可用于那些合成吊带放置失败的患者。对于那些存在网片侵蚀高风险的患者，如免疫功能低下或放疗后患者，也较为适用。本视频回顾了一位免疫功能低下、多次腹部手术的患者行自体耻骨阴道吊带（取自腹直肌筋膜）的技术要点。
患者为 63 岁女性，SUI 经保守治疗无效，长期服用类固醇治疗贝切特病。首先，通过经耻骨联合上缘的Pfannenstiel 切口切取 12cm×2cm 的腹直肌鞘移植物。放置缝线以辅助后续吊带放置。在利多卡因/肾上腺素溶液水分离后，在前阴道壁做一垂直切口，钝性和锐性分离相结合来分离该平面。带有附着筋膜吊带的套管经耻骨后穿过。用 Q-tip 试验评估吊带张力。术中膀胱镜检查时发现左侧套管通过时发生膀胱意外穿孔，术后行导尿一周保守治疗。
患者术后第 2 天顺利出院，术后第 7 天成功拔除导尿管。术后 1 个月随访时，患者报告 SUI 完全缓解，无新发尿急或排尿功能障碍。
自体耻骨阴道吊带是治疗 SUI 的有效方法，具有最小的发病率，尤其适用于网片侵蚀高风险的患者。
