Schär G, Köchli O R, Fink D, Haller U
Universitätsfrauenklinik Zürich, Schweiz.
Gynakol Geburtshilfliche Rundsch. 1993;33(2):94-102. doi: 10.1159/000272076.
By means of 5 typical examples, repeated problems in the operative strategy of incontinence and descensus are discussed. Prior to each vaginal repair a urodynamic examination should be done to clarify the risk of incontinence. In the case of vaginal repair the periurethral structures should be preserved. In the case of abdominal colposuspension nonabsorbable suture material should be used. A wide elevation should be avoided. Continent patients with a cystocele and a urodynamically verified, hidden stress incontinence need, in addition, a vaginal colposuspension. In the case of vaginal stump prolapse the organ-saving operation (vaginal sacropexy) should be preferred to colpectomy. In the case of recurring stress incontinence, patients should preoperatively undergo an intensive local therapy, thus enabling a tension-free elevation.
通过5个典型病例，讨论了尿失禁和子宫脱垂手术策略中反复出现的问题。每次阴道修复术前均应进行尿动力学检查，以明确尿失禁风险。阴道修复时应保留尿道周围结构。腹式阴道悬吊术应使用不可吸收缝合材料。应避免广泛抬高。对于患有膀胱膨出且经尿动力学证实存在隐匿性压力性尿失禁的控尿患者，还需要进行阴道阴道悬吊术。对于阴道残端脱垂，应首选保留器官的手术（阴道骶骨固定术）而非阴道切除术。对于复发性压力性尿失禁患者，术前应进行强化局部治疗，从而实现无张力抬高。
