Cross C A, Cespedes R D, English S F, McGuire E J
Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas Medical School at Houston, USA.
J Urol. 1998 Apr;159(4):1199-201.
Urethral obstruction following a stress incontinence procedure occurs in 5 to 20% of patients. We examine the success of transvaginal urethrolysis in resolving voiding dysfunction.
A retrospective chart review was performed on 39 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, and pelvic examination and either video urodynamics or cystoscopy were done.
All 39 patients complained of urge incontinence, 13% had urinary retention, 51% had incomplete bladder emptying and 36% voided to completion but had irritative voiding symptoms. Previous surgery included retropubic urethropexy in 41% of the cases, pubovaginal sling in 38% and bladder neck suspension in 21%. Mean length of followup after urethrolysis was 16 months. Of the 39 patients 33 (85%) had resolution of urge incontinence but 5 still required occasional intermittent catheterization. The remaining 6 patients had continued urge incontinence. An augmentation procedure was performed in 4 patients with improvement of symptoms.
Our data support transvaginal urethrolysis for the treatment of iatrogenic urethral obstruction. It is a rapid, effective and minimally invasive technique that should be considered if voiding dysfunction does not resolve spontaneously.
压力性尿失禁手术后尿道梗阻在5%至20%的患者中出现。我们研究经阴道尿道松解术解决排尿功能障碍的成功率。
对39例因抗尿失禁手术后尿道梗阻而接受经阴道尿道松解术的患者进行回顾性病历审查。术前，采集病史，并进行盆腔检查以及视频尿动力学检查或膀胱镜检查。
所有39例患者均主诉急迫性尿失禁，13%有尿潴留，51%膀胱排空不全，36%能完全排尿但有刺激性排尿症状。既往手术包括41%的耻骨后尿道固定术、38%的耻骨阴道吊带术和21%的膀胱颈悬吊术。尿道松解术后平均随访时间为16个月。39例患者中，33例（85%）急迫性尿失禁得到缓解，但5例仍需偶尔进行间歇性导尿。其余6例患者仍有持续性急迫性尿失禁。4例患者进行了扩大手术，症状有所改善。
我们的数据支持经阴道尿道松解术治疗医源性尿道梗阻。它是一种快速、有效且微创的技术，如果排尿功能障碍不能自发缓解，应予以考虑。
