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中段尿道吊带所致尿道糜烂的表现及处理

Presentation and management of urethral erosion caused by mid-urethral sling.

作者信息

Lynch Olwyn E, O'Connor Eabhann M, Barea Bianca, Forde James C

机构信息

Department of Urology, Beaumont Hospital, Dublin 9, Ireland.

出版信息

Ir J Med Sci. 2025 Apr 28. doi: 10.1007/s11845-025-03949-w.

Abstract

BACKGROUND

Mid-urethral slings (MUS) have been the standard of care in surgical management of female stress urinary incontinence (SUI) internationally. Complications including pain and erosion has led to a temporary "pause" of their use in the UK and Ireland. We report on our experience to date on patient presentation, operative management, and post-operative outcomes in management of MUS erosion.

METHODS

Review of female patients who had partial MUS removal due to urethral erosion over a 7-year period. Data on patient presentation, operative technique, and post-operative outcomes were collected and collated.

RESULTS

A total of 21 patients were identified. Overall, 66% of patients presented with symptoms of urinary tract infection (UTI). Other presentations include overactive bladder symptoms (52%), recurrent incontinence (42%), or dyspareunia (9%). Some patients presented with a combination of these symptoms. Overall, 9 patients had a trans-obturator tape (TOT), 6 had a trans-vaginal tape (TVT), and 4 had unspecified type of MUS. Two patients had 2 previous MUS insertions. Initial operative management with urethroscopy and laser fragmentation in cases with significant MUS calcification was required in 18% (n = 4) of patients. A total of 86% (n = 18) of patients had urethral erosion that required formal urethral repair and a short period with an indwelling catheter. All patients had resolution of their UTI symptoms post procedure. Fifteen patients required further surgical intervention to manage recurrent incontinence after MUS removal.

CONCLUSION

Partial removal of MUS due to urethral erosion improves patient symptoms. However, the majority have recurrence of SUI and require further intervention.

摘要

背景

在国际上,中段尿道吊带术(MUS)一直是女性压力性尿失禁(SUI)外科治疗的标准方法。包括疼痛和侵蚀在内的并发症导致其在英国和爱尔兰的使用暂时“暂停”。我们报告了迄今为止我们在MUS侵蚀管理中关于患者表现、手术管理和术后结果的经验。

方法

回顾7年间因尿道侵蚀而部分切除MUS的女性患者。收集并整理有关患者表现、手术技术和术后结果的数据。

结果

共确定了21例患者。总体而言,66%的患者出现尿路感染(UTI)症状。其他表现包括膀胱过度活动症症状(52%)、复发性尿失禁(42%)或性交困难(9%)。一些患者表现出这些症状的组合。总体而言,9例患者使用了经闭孔尿道中段吊带术(TOT),6例使用了经阴道尿道中段吊带术(TVT),4例使用了未指明类型的MUS。2例患者曾接受过2次MUS植入。18%(n = 4)的患者在MUS严重钙化的情况下需要进行初步手术管理,即通过尿道镜检查和激光破碎术。共有86%(n = 18)的患者出现尿道侵蚀,需要进行正式的尿道修复并短期留置导尿管。所有患者术后UTI症状均得到缓解。15例患者在MUS切除后需要进一步手术干预以处理复发性尿失禁。

结论

因尿道侵蚀而部分切除MUS可改善患者症状。然而,大多数患者会出现SUI复发,需要进一步干预。

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