Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University and Hadassah School of Medicine in Jerusalem, 76100, Rehovot, Israel.
University of Sydney, Sydney, NSW, Australia.
Int Urogynecol J. 2022 Aug;33(8):2195-2201. doi: 10.1007/s00192-022-05186-6. Epub 2022 Apr 11.
We assessed rotation/twisting of transobturator midurethral slings (TOTs) and tested for associations with de novo chronic pain and voiding dysfunction.
A retrospective pilot study including patients seen after Monarc™ TOT surgery at a single tertiary hospital in 2005-2016. Patients underwent an interview, clinical examination, uroflowmetry and 4D pelvic floor ultrasound. Volume datasets were analyzed blinded against all other data. Sling rotation/twisting was evaluated in volumes obtained at rest. The sling axis was measured relative to the vertical in the midline and in the most lateral parasagittal slice. Total sling rotation was calculated by summation of absolute angle differences between midline and lateral angles. "Corkscrew" rotation was noted when direction of rotation was opposite on the contra-lateral side.
The study included 215 patients. Fifty-two (24%) were excluded, leaving 163. Mean age was 57 years (28-87; SD 12), mean BMI 29.4 kg/m (18.3-47.4, SD 6). Follow-up was at a median of 17 months (IQR 11-27). Chronic de novo pain was reported by 15 women (9%; dyspareunia by 11 and pelvic/vaginal pain by 4). On imaging, mean total sling rotation was 144° (12-335, SD 56). In the majority (n = 103, 63%) it rotated counter-clockwise from its midline position and in 30 (18%) it rotated clockwise. "Corkscrew" rotation was noted in 30 (18%). De novo chronic pain was associated with lower BMI and vaginal sling exposure but not with sling rotation. The latter was not found to be associated with voiding dysfunction either.
Monarc™ TOTs rotate considerably throughout their course. The degree of twisting or rotation and its direction was not found to be associated with de novo postoperative chronic pain or voiding dysfunction.
我们评估了经闭孔尿道中段吊带（TOTs）的旋转/扭转，并研究了其与新发慢性疼痛和排尿功能障碍的关系。
这是一项回顾性的试点研究，纳入了 2005 年至 2016 年在一家三级医院接受 Monarc™TOT 手术后的患者。患者接受了访谈、临床检查、尿流率和 4D 盆底超声检查。体积数据集在不考虑其他数据的情况下进行盲法分析。在休息时获得的容积中评估吊带的旋转/扭转。吊带轴相对于中线和最外侧矢状位切片的垂直方向进行测量。通过中线和外侧角度之间的绝对角度差的总和计算总吊带旋转。当对侧旋转方向相反时，记录为“螺旋”旋转。
该研究纳入了 215 名患者。52 名（24%）被排除，留下 163 名患者。平均年龄为 57 岁（28-87；SD 12），平均 BMI 为 29.4kg/m²（18.3-47.4，SD 6）。中位随访时间为 17 个月（IQR 11-27）。15 名女性（9%）报告新发慢性疼痛（性交痛 11 例，盆腔/阴道疼痛 4 例）。影像学检查显示，平均总吊带旋转为 144°（12-335，SD 56）。在大多数患者（n=103，63%）中，吊带从中线位置逆时针旋转，30 名患者（18%）顺时针旋转。30 名患者（18%）出现“螺旋”旋转。新发慢性疼痛与较低的 BMI 和阴道吊带暴露有关，但与吊带旋转无关。后者也与排尿功能障碍无关。
Monarc™TOT 在整个过程中会发生明显的旋转。扭转或旋转的程度及其方向与新发术后慢性疼痛或排尿功能障碍无关。
