Weinberger M W, Ostergard D R
Department of Obstetrics and Gynecology, University of Wisconsin, Madison, USA.
Obstet Gynecol. 1996 Jan;87(1):50-4. doi: 10.1016/0029-7844(95)00347-9.
To determine the incidence of permanent voiding dysfunction after polytetrafluoroethylene suburethral sling placement, and to assess the effect of voiding mechanism and uroflowmetry on the duration of postoperative catheterization.
Between January 1986 and April 1991, 108 patients underwent suburethral sling procedures to treat genuine stress incontinence. Medical records were reviewed to collect urodynamic and catheterization data. One year or longer after surgery, 98 women completed a telephone interview evaluating incontinence, self-catheterization, and voiding symptoms.
The mean duration of postoperative cathtrerization was 10.7 weeks. There was no significant relationship between preoperative uroflow indices and the duration of catheterization. The presence of a preoperative detrusor contraction was associated with a shorter mean duration of postoperative catheterization (6.1 versus 14.8 weeks, P = .07) and a lower risk of sling removal for retention (7 versus 33%, P = .04). Eight patients continued self-catheterization. Fourteen patients reported other micturition problems: three used the Credé maneuver or double voided to facilitate emptying and 11 were unable to urinate when seated upright. There was no correlation between the duration of catheterization and ongoing voiding dysfunction. Among nine women who underwent further surgery to treat postoperative urinary retention, three continue to catheterize, one performs Credé, and one urinates standing.
Polytetrafluoroethylene suburethral sling placement commonly produces permanent voiding difficulty. Patients who void without a detrusor contraction are at increased risk for prolonged postoperative catheterization. Sling removal does not ensure resolution of urinary retention and may be no better than leaving the sling in place.
确定聚四氟乙烯尿道下吊带置入术后永久性排尿功能障碍的发生率，并评估排尿机制和尿流率对术后留置导尿管时间的影响。
1986年1月至1991年4月期间，108例患者接受了尿道下吊带手术以治疗真性压力性尿失禁。回顾病历以收集尿动力学和导尿管留置数据。术后一年或更长时间，98名女性完成了电话访谈，评估尿失禁、自我导尿和排尿症状。
术后留置导尿管的平均时间为10.7周。术前尿流指标与导尿管留置时间之间无显著关系。术前存在逼尿肌收缩与术后较短的平均导尿管留置时间（6.1周对14.8周，P = 0.07）和因尿潴留而取出吊带的较低风险（7%对33%，P = 0.04）相关。8例患者继续进行自我导尿。14例患者报告了其他排尿问题：3例使用耻骨上按压法或二次排尿以促进排空，11例在直立坐位时无法排尿。导尿管留置时间与持续存在的排尿功能障碍之间无相关性。在9例接受进一步手术治疗术后尿潴留的女性中，3例继续导尿，1例进行耻骨上按压法，1例站立排尿。
聚四氟乙烯尿道下吊带置入术常导致永久性排尿困难。无逼尿肌收缩而排尿的患者术后导尿管留置时间延长的风险增加。取出吊带并不能确保解决尿潴留问题，可能并不比保留吊带更好。
