Even L, Tibi B, Bentellis I, Treacy P J, Berrogain N, Bosset P O, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu J-F, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu J N
Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France.
Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France.
Prog Urol. 2021 Dec;31(17):1141-1166. doi: 10.1016/j.purol.2021.09.007. Epub 2021 Nov 15.
Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term.
In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected.
Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women.
Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
在法国，中段尿道吊带置入术是女性压力性尿失禁外科治疗的金标准。这种材料的治愈率已无需证明，但围手术期和术后并发症目前不仅在欧洲，而且在英吉利海峡对岸和大西洋彼岸都引发了越来越多的争议，导致手术适应症发生了改变。在法国，相关建议也在不断演变，多学科会诊会议对手术适应症的框架要求更为严格，并且规定了术后短期和长期随访的义务。
在此背景下，CUROPF对文献进行了综述，汇总了有关中段尿道吊带置入术围手术期和术后并发症发生情况的现有科学证据。使用Medline数据库进行了文献检索，共筛选出123篇文章。
数据分析突出了各种并发症，具体取决于植入材料、患者和手术适应症。耻骨后中段尿道吊带在手术期间会导致更多膀胱侵蚀（高达14%）、更多耻骨上疼痛（高达4%）、更多急性尿潴留（高达19.7%）和术后排尿困难（高达26%）。经闭孔中段尿道吊带在手术期间会导致更多阴道侵蚀（高达10.9%）、更多神经源性下肢疼痛（高达26.7%）。两种手术发生膀胱过度活动症的风险相似（高达33%）。但这些并发症风险必须与尿失禁手术对这些女性整体生活质量的重大影响相权衡。
因此，手术失败和长期并发症确实存在，但不应限制使用中段尿道吊带治疗压力性尿失禁。应对女性进行个体化决策治疗，并且有必要进行长期随访。
