Harris R L, Cundiff G W, Theofrastous J P, Yoon H, Bump R C, Addison W A
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Obstet Gynecol. 1997 Dec;177(6):1367-9; discussion 1369-71. doi: 10.1016/s0002-9378(97)70077-2.
Our goal was to evaluate the role of intraoperative cystoscopy during surgery for pelvic organ prolapse and urinary incontinence.
Charts of 224 consecutive patients who had intraoperative cystoscopy performed after urogynecologic surgery were reviewed.
Nine injuries occurred that were unsuspected before cystoscopy, for an incidence of 4%. Six ureteral ligations occurred, four after Burch cystourethropexy and two after vaginal culdoplasty. Intravesical sutures were noted after two Burch procedures, and another injury occurred with passage of fascia lata through the bladder during a pubovaginal sling procedure. Eight injuries were managed by removal and replacement of the suture or sling with only one requiring ureteroneocystotomy. When patients with injuries were compared with those without, there were no statistical differences in demographic or surgical parameters.
The potential for damage to the lower urinary tract is significant with complex urogynecologic surgery. Because of the increased and delayed morbidity associated with unrecognized injury, intraoperative surveillance cystoscopy should be considered a part of all such procedures.
我们的目标是评估术中膀胱镜检查在盆腔器官脱垂和尿失禁手术中的作用。
回顾了224例在泌尿妇科手术后进行术中膀胱镜检查的连续患者的病历。
发生了9例在膀胱镜检查前未被怀疑的损伤，发生率为4%。发生了6例输尿管结扎，4例在Burch膀胱尿道悬吊术后，2例在阴道后穹隆成形术后。在2例Burch手术之后发现膀胱内有缝线，并且在耻骨后阴道吊带手术期间阔筋膜穿过膀胱时发生了另一例损伤。8例损伤通过拆除并更换缝线或吊带进行处理，只有1例需要输尿管膀胱吻合术。将有损伤的患者与无损伤的患者进行比较时，在人口统计学或手术参数方面没有统计学差异。
复杂的泌尿妇科手术对下尿路造成损伤的可能性很大。由于未被识别的损伤会增加发病率并导致发病延迟，术中监测膀胱镜检查应被视为所有此类手术的一部分。
