Bombieri L, Freeman R M
Urogynaecology Unit, Derriford Hospital, Plymouth, UK.
Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(1):58-60. doi: 10.1007/BF01900546.
Management of vault prolapse in a patient who has previously undergone successful colposuspension has not been considered in the literature. The two cases presented highlight the risk of incontinence and illustrate measures that should help to reduce it. The approach aims to reveal potential stress incontinence and to prevent excessive stretching of the upper anterior vaginal wall during surgical correction. Potential stress incontinence is revealed by a cough stress test while reducing the prolapse without a speculum, a 'pessary test' for a few days, and urodynamics both with and without a pessary. Patients with potential incontinence undergo perineal ultrasound to assess bladder neck position. If sacrospinous fixation is used, epidural anesthesia is recommended so as to allow the patient to cough during the procedure to ensure accurate suture placement. When sacrocolpopexy is done, preoperative assessment of the degree of 'safe elevation' ensures accurate suture placement.
既往成功进行过阴道前壁悬吊术的患者发生穹窿脱垂的管理在文献中尚未被探讨。所呈现的两例病例突出了尿失禁的风险，并说明了有助于降低该风险的措施。该方法旨在发现潜在的压力性尿失禁，并在手术矫正期间防止阴道前壁上部过度伸展。在不使用窥器复位脱垂时通过咳嗽压力试验、进行几天的“子宫托试验”以及使用和不使用子宫托时进行尿动力学检查来发现潜在的压力性尿失禁。存在潜在尿失禁的患者接受会阴超声检查以评估膀胱颈位置。如果采用骶棘肌固定术，建议使用硬膜外麻醉以便在手术过程中让患者咳嗽以确保准确放置缝线。当进行骶骨阴道固定术时，术前评估“安全提升”程度可确保准确放置缝线。
