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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 尿道懸吊手術造成膀胱出口阻塞的探討 | 2012/3/29 上午 10:15:05 | 0 |
| 原 文 | 題 目 | Outlet obstruction after sling surgery |
| 作 者 | Vincent Tse and Lewis Chan. | |
| 出 處 | British Journal of Urology international | |
| 出版日期 | 108(supple 2):24-28; 2011 | |
| 評 論 |
Mid-urethral synthetic sling (MUS)在目前已經是女性stress incontinence最普遍的手術治療方式。但術後的併發症之中，膀胱出口阻塞 (bladder outlet obstruction, BOO) 的發生亦時有所聞。本文目的在探討會造成術後BOO的預測因子、診斷及治療方式。據文獻分析 preoperative Qmax <15 ml/s或是 detrusor hypocontractility on pre-op urodynamic study 的病患，較易發生術後的出口阻塞。此外作者提出translabial ultrasound 來觀察病患是否有sling migration or kinking of the urethra的現象，它的優點是可以提供less distorted view of the urethra than the transvaginal approach；此外如果術後urodynamic study 顯示 low Qmax and high detrusor voiding pressure at Qmax，且合併fluoroscopic features of obstruction at bladder neck or urethra，也是診斷是否產生術後出口阻塞的重要方式。 至於治療方面，藥物可以首先用來改善storage symptoms，但如果不能改善，便需要考慮cysto-urethroscopy 來排除 obstruction or erosion。通常建議 retention in the first 2 weeks 以間歇性導尿 (clean intermittent catheterization) 處置，但如果失敗，則可以選擇 sling loosening、sling incision or urethrolysis 的手術治療方式。 最後，作者提醒我們 prevention is better than cure， 因此， proper patient ion and avoid excessive tension during sling operation 是非常重要的關鍵。 |
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| abstract |
Department of Urology, Concord Repatriation General Hospital, Sydney, Australia. vwmtse@gmail.com Urethral obstruction is not an uncommon complication after sling surgery for female stress urinary incontinence (SUI). This paper focuses on this complication in the context of the mid-urethral synthetic sling, which is now the predominate surgical option used by many surgeons in the treatment of female SUI. The epidemiology and risk factors predisposing to sling obstruction is reviewed, followed by a description of clinical features used in supporting the diagnosis. The use of urodynamics in conjunction with translabial ultrasound as a novel approach to assess the position of the sling and its relation to the urethra is explained. This is particularly important in the understanding of why the sling obstructs from an anatomical standpoint. The paper concludes with a brief overview on treatment options. |
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