Hom D, Desautel M G, Lumerman J H, Feraren R E, Badlani G H
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Urology. 1998 May;51(5):708-13. doi: 10.1016/s0090-4295(98)00111-3.
To report preliminary results from a modified pubovaginal sling procedure using polypropylene mesh as the sling suspended by nonabsorbable sutures anchored to the pubic tubercle with Vesica bone anchors.
Thirty-five women with type III stress urinary incontinence (SUI) (with or without associated urethral hypermobility) or type II SUI with additional risk factors such as obesity, chronic obstructive pulmonary disease, or failed prior incontinence-correcting procedures underwent this modified pubovaginal sling procedure. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys.
With a mean follow-up of 8.4 months (range 2 to 18), 32 women (91.4%) were dry, 1 improved, and 2 remained incontinent. The pubovaginal sling procedure was the only operation performed in 46% of patients, with a mean operative time of 72 minutes, a mean estimated blood loss of 137 mL, and a mean hospital period of 2.3 days. Patients on whom concomitant gynecologic procedures were performed had a mean duration of surgery of 122 minutes, a mean estimated blood loss of 202 mL, and a mean hospitalization period of 2.9 days. Thirteen women had preoperative urgency that persisted in 31% of patients. De novo urgency developed in 3 patients. Seven women required prolonged suprapubic tube drainage but no patient remained in permanent retention. There has been no infection or erosion.
Our experience with this modified pubovaginal sling procedure using polypropylene mesh and Vesica bone anchors showed excellent results with greater technical ease, minimal morbidity, and decreased hospitalization period when compared to a traditional pubovaginal sling performed in our hands. Additional follow-up will be needed to assess long-term efficacy.
报告采用聚丙烯网片作为吊带，通过不可吸收缝线将其悬吊于耻骨结节并使用Vesica骨锚固定的改良耻骨后阴道吊带术的初步结果。
35例患有Ⅲ型压力性尿失禁（SUI）（伴或不伴有尿道活动过度）或伴有肥胖、慢性阻塞性肺疾病等额外危险因素或既往尿失禁矫正手术失败的Ⅱ型SUI女性接受了这种改良耻骨后阴道吊带术。在门诊随访和电话调查期间评估术后排尿情况。
平均随访8.4个月（范围2至18个月），32例女性（91.4%）无尿失禁，1例改善，2例仍有尿失禁。46%的患者仅接受了耻骨后阴道吊带术，平均手术时间为72分钟，平均估计失血量为137毫升，平均住院时间为2.3天。同时接受妇科手术的患者平均手术时长为122分钟，平均估计失血量为202毫升，平均住院时间为2.9天。13例女性术前存在尿急，31%的患者术后仍有尿急。3例患者出现新发尿急。7例女性需要延长耻骨上管引流时间，但无一例患者持续永久性尿潴留。未发生感染或侵蚀。
我们使用聚丙烯网片和Vesica骨锚进行这种改良耻骨后阴道吊带术的经验显示，与我们开展的传统耻骨后阴道吊带术相比，该术式效果极佳，操作更简便，发病率更低，住院时间更短。需要进一步随访以评估长期疗效。
