Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
Int Urogynecol J. 2022 Apr;33(4):1001-1006. doi: 10.1007/s00192-021-04759-1. Epub 2021 Apr 6.
The objective was to report the management of post-operative urinary incontinence after midurethral sling (MUS) revision for chronic pelvic pain (CPP), and to report functional outcomes.
From November 2004 to February 2018, a total of 89 women who underwent removal or section of MUS for CPP, were enrolled. Patients were divided into the transobturator tape (TOT) group (50 patients) and the tension-free vaginal tape (TVT) group (37 patients); 2 patients had had both slings implanted. We report the rate of stress urinary incontinence (SUI) recurrence, the rate of de novo urge urinary incontinence (UUI), the need for subsequent SUI or UUI surgery, and functional outcomes (pain and continence).
Median follow-up was 41.4 months [0.9-138.8]. SUI recurrence or de novo UUI occurred in 52 cases (58.4%): 19 (51.3%) patients in the TVT group, 31 (62%) in the TOT group, and both patients (100%) who underwent total removal of both slings. Among patients with SUI recurrence or de novo UUI, 39 (75%) had pain relief after sling removal. Seventeen patients (32.6%) refused any treatment, 14 (26.9%) were cured with conservative therapy, and 21 (40.3%) underwent SUI or UUI surgery. One patient had de novo pelvic pain after reoperation. The overall continence rate for all patients who underwent sling revision was 82% (73 out of 89) at the last follow-up.
After MUS revision for CPP, post-operative UI may occur in 58.4% of patients, of which, one-fourth may be managed with conservative measures only. Forty percent of them had redo surgery with a low risk of pain recurrence and a high rate of urinary continence.
目的在于报告因慢性盆腔痛（CPP）而对尿道中段吊带（MUS）进行翻修术后尿失禁的处理方法，并报告功能结果。
2004 年 11 月至 2018 年 2 月，共有 89 名因 CPP 而行 MUS 切除或部分切除的女性患者入组。患者分为经闭孔吊带（TOT）组（50 例）和无张力阴道吊带（TVT）组（37 例）；2 例患者同时植入了两种吊带。我们报告压力性尿失禁（SUI）复发率、新发急迫性尿失禁（UUI）率、需要后续 SUI 或 UUI 手术的情况以及功能结果（疼痛和控尿）。
中位随访时间为 41.4 个月[0.9-138.8]。52 例（58.4%）患者出现 SUI 复发或新发 UUI：TVT 组 19 例（51.3%），TOT 组 31 例（62%），两种吊带均完全切除的患者 2 例（100%）。在 SUI 复发或新发 UUI 的患者中，39 例（75%）吊带切除后疼痛缓解。17 例（32.6%）拒绝任何治疗，14 例（26.9%）采用保守治疗治愈，21 例（40.3%）行 SUI 或 UUI 手术。1 例患者再手术后新发盆腔痛。所有接受吊带翻修的患者在末次随访时的总体控尿率为 82%（89 例中的 73 例）。
因 CPP 而行 MUS 翻修术后，58.4%的患者可能出现术后尿失禁，其中四分之一可能仅采用保守治疗即可解决。其中 40%的患者接受了再次手术，疼痛复发率低，尿控率高。
