Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France.
University of Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
Int Urogynecol J. 2022 Mar;33(3):627-635. doi: 10.1007/s00192-021-04771-5. Epub 2021 Mar 31.
Tapes for stress urinary incontinence (SUI) and meshes for pelvic organ prolapse can result in postoperative complications, such as urethral (UP) or bladder (BP) perforations. Martius fat pad (MFP) is an historic procedure, widely used to treat lower urinary tract (LUT) fistulae. We report our experience with the insertion of the biological small intestinal submucosa (SIS) xenograft as an alternative to MFP in these prosthetic complications.
We conducted a retrospective, monocentric study which included all patients who underwent SIS insertion during surgical removal of tape/vaginal mesh for UP or BP from 2011 to 2019. Preoperative assessment was based on history, symptoms, physical examination and urethrocystoscopy. Primary outcome was successful repair defined as absence of any LUT defect. Secondary outcomes were complications, LUT symptoms, pain and additional SUI surgical procedures.
Thirty-eight patients were included. Twenty-six had a UP and eight a BP. In four cases, perforation involved both the bladder neck and urethra. All LUT defects were cured. Six postoperative complications were reported (five of grade ≤ 2 and one of grade 3b according to the Clavien-Dindo classification). At the mean follow-up of 37.2 (range 6-98) months, 14 patients (36.8%) presenting a postoperative SUI underwent a SUI surgical procedure and 1 patient had a laparoscopic sacrocolpopexy for cystocele recurrence.
Absorbable SIS xenograft is an effective and safe graft for the management of lower urinary tract tape and mesh perforations. The cost has to be balanced with the good results, short operative time and no fat pad complications as in MFP.
用于治疗压力性尿失禁（SUI）的吊带和用于治疗盆腔器官脱垂的网片可能导致术后并发症，如尿道（UP）或膀胱（BP）穿孔。Martius 脂肪垫（MFP）是一种历史悠久的手术方法，广泛用于治疗下尿路（LUT）瘘。我们报告了在治疗这些假体并发症时，将生物小肠黏膜下层（SIS）移植物插入作为 MFP 的替代物的经验。
我们进行了一项回顾性、单中心研究，该研究纳入了 2011 年至 2019 年期间因 UP 或 BP 行吊带/阴道网片切除术中插入 SIS 的所有患者。术前评估基于病史、症状、体格检查和尿道膀胱镜检查。主要结果是定义为无任何 LUT 缺陷的成功修复。次要结果是并发症、LUT 症状、疼痛和额外的 SUI 手术。
共纳入 38 例患者。26 例为 UP，8 例为 BP。4 例患者的穿孔同时累及膀胱颈部和尿道。所有的 LUT 缺损均治愈。报告了 6 例术后并发症（根据 Clavien-Dindo 分类，5 例为≤2 级，1 例为 3b 级）。在平均 37.2 个月（6-98 个月）的随访中，14 例（36.8%）术后存在 SUI 的患者行 SUI 手术，1 例患者因膀胱膨出复发行腹腔镜骶骨阴道固定术。
可吸收 SIS 移植物是治疗下尿路吊带和网片穿孔的有效且安全的移植物。成本必须与良好的结果、手术时间短以及没有像 MFP 那样的脂肪垫并发症相平衡。
