Pandey Deeksha, Jatana Vaishnavi, Inukollu Pranadeep Reddy, Fuenfgeld Christian
OBG, KMC Manipal, MAHE, India.
Klinik Tettnang, Germany.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:78-84. doi: 10.1016/j.ejogrb.2021.03.002. Epub 2021 Mar 15.
Mid-urethral sling (MUS) surgeries have revolutionized the management of stress urinary incontinence (SUI). However, MUS is a delicate balance of tension on the mid urethral segment with a 12 % risk of failure to achieve complete continence; and up-to 20 % chance of post-operative voiding dysfunction. We propose a simple technical modification in which the long ends of the tape at suprapubic or groin area are not cut immediately and are covered with a sterile dressing. After 48-72 h post-surgery the patient is checked for continence and voiding difficulties. Following this an ultrasonographic assessment of post-void residual urine is performed. Keeping in mind these 3 criteria the tape is adjusted. After complete subjective as well as objective satisfaction the long ends of tape are cut.
This is a retrospective analysis of women who underwent MUS surgery for the management of SUI, with our simple technical modification of tape adjustment in the postoperative period. A total of 17 patients operated by single surgeon in one year were included.
Our results show that 58.8 % of our patients who underwent MUS procedures required post-operative tape adjustment. The number was significantly higher in the MUS - Retropubic group (85.7 %) as compared to the MUS - Obturator group (40 %). Three patients in the MUS - Retropubic group required a second time tape adjustment. Following tape adjustment all patients had complete continence (subjective and objective), with no voiding dysfunction.
The incidence of postoperative voiding dysfunction is significant following MUS surgery for SUI. A simple technical modification of delaying the cutting of the tape for two to three days gives the opportunity for perfect tension adjustment.
中段尿道吊带术（MUS）彻底改变了压力性尿失禁（SUI）的治疗方式。然而，MUS是在中段尿道施加张力的精细平衡，完全控尿失败的风险为12%；术后排尿功能障碍的几率高达20%。我们提出一种简单的技术改良方法，即耻骨上或腹股沟区吊带的长端不立即剪断，而是用无菌敷料覆盖。术后48 - 72小时检查患者的控尿情况和排尿困难。在此之后，进行超声检查评估排尿后残余尿量。根据这三个标准对吊带进行调整。在主观和客观上都达到完全满意后，再剪断吊带的长端。
这是一项对因SUI接受MUS手术并在术后采用我们改良的吊带调整技术的女性患者进行的回顾性分析。共纳入了一年内由同一位外科医生手术的17例患者。
我们的结果显示，接受MUS手术的患者中有58.8%需要术后吊带调整。与闭孔型MUS组（40%）相比，耻骨后MUS组（85.7%）这一比例明显更高。耻骨后MUS组有3例患者需要再次进行吊带调整。吊带调整后，所有患者均实现了完全控尿（主观和客观），且无排尿功能障碍。
SUI的MUS手术后，术后排尿功能障碍的发生率较高。一种简单的技术改良，即延迟两到三天剪断吊带，为完美调整张力提供了机会。
