Lam Lai-Yet, Santos-Cortes Janice A, O'Rourke Timothy K
Division of Gynecology, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Case Rep Womens Health. 2023 Jul 27;39:e00530. doi: 10.1016/j.crwh.2023.e00530. eCollection 2023 Sep.
Stress urinary incontinence affects more than one-fourth of adult women. The recommended surgical treatment involves the use of a synthetic mesh sling. Upon unsuccessful treatment using a mesh sling or when patients decline mesh, surgical treatments, including an autologous fascia sling, colposuspension, or bulking injections, are used. After unsuccessful treatment using three mesh slings, an autologous fascia sling, and a midurethral bulking agent, a patient was successfully treated with our modified Kelly plication technique. A 51-year-old woman with recurrent stress urinary incontinence had had three previous mesh midurethral sling exposures with complete mesh removals followed by one autologous fascia sling with severe infection. We initially treated her with a set of urethral bulking injections, which was also unsuccessful. She was successfully treated with our modified Kelly plication technique, which plicates levator ani muscles to support the midurethral instead of plicating the vesicovaginal fascia at the bladder neck. The patient remained continent four years after the performance of this technique and had reported no pelvic pain or dyspareunia. The technique is detailed in this paper. This single vaginal incision native tissue technique may be considered when mesh slings or alternative native tissue procedures are not feasible for patients, as in this case.
压力性尿失禁影响超过四分之一的成年女性。推荐的手术治疗方法是使用合成网状吊带。当使用网状吊带治疗失败或患者拒绝使用网状物时，则采用包括自体筋膜吊带、阴道前壁悬吊术或填充注射在内的手术治疗方法。在使用三种网状吊带、一种自体筋膜吊带和一种尿道中段填充剂治疗失败后，一名患者通过我们改良的凯利折叠术成功治愈。一名51岁复发性压力性尿失禁的女性此前曾进行过三次网状尿道中段吊带取出术，随后进行了一次自体筋膜吊带术，但出现严重感染。我们最初用一组尿道填充注射剂对她进行治疗，也未成功。她通过我们改良的凯利折叠术成功治愈，该技术通过折叠肛提肌来支撑尿道中段，而不是在膀胱颈处折叠膀胱阴道筋膜。该技术实施四年后，患者仍保持控尿状态，且未报告盆腔疼痛或性交困难。本文详细介绍了该技术。当网状吊带或其他自体组织手术对患者不可行时，如本病例，可考虑这种单一阴道切口自体组织技术。
