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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李建達 | 有多少比例的病人會在urethrolysis之後，再度回到有尿失禁的問題？ | 2007/2/28 上午 12:00:47 | 1 |
| 原 文 | 題 目 | Long-term urinary continence rates after simple sling incision for relief of urinary retention following fascia lata pubovaginal slings. |
| 作 者 | Thiel DD, Pettit PD, McClellan WT, and Petrou SP | |
| 出 處 | J Urol. ; 174(5): 1878-81. | |
| 出版日期 | 2005 Nov | |
| 評 論 |
（筆者：國軍臺中總醫院泌尿外科主任 李建達醫師） 近年來，許多尿失禁的患者接受了泌尿科或婦產科醫師的手術治療；根據統計這些抗尿失禁手術後的病人約有5~20%（Ref. 1, 2）會造成尿道阻塞的困擾。隨著阻塞的時間越久，膀胱恢復的功能會越差（Ref. 3）；所以適當的病人來進行尿道緩解手術（urethrolysis）是必要的。 根據各文獻的報告，urethrolysis的成功率約在65~93%（Ref. 4, 5）；而筆者最常被問到及最擔心的是，到底有多少比例的病人會在urethrolysis之後，再度回到有尿失禁的問題？ 這個答案在相關的文獻報導約3~18%左右（Ref. 4, 6, 7, 8），本文報導經陰道做尿道的緩解手術之後再度應力性尿失禁的機會是0～19﹪，但並不建議手術的同時，再做懸吊手術。這個觀點與我的指導老師Dr. Appell是相同的。 依本文的結論加上筆者個人的淺見：如果尿失禁的病人在接受手術治療後，造成Bladder outlet obstruction有臨床症狀與尿路動力學的各種證據，則依序有下列的解決之道。先使用midline simple sling incision；再formal transvaginal urethrolysis（Ref. 2, 4）；碰到複雜或recurrence需repeat urethrolysis者，建議加上Martius flap procedure（Ref. 5）。 參考文獻： 1. Cross CA, Cespedes RD, English SF, McGuire EJ. Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. 1998 Apr; 159(4): 1199-201. 2. Dunn JS Jr, Bent AE, Ellerkman RM, Nihira MA, Melick CF. Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J Pelvic Floor Dysfunct. 2004 Jan-Feb; 15(1): 25-31; discussion 31. Epub 2003 Dec 19. Review. 3. Leng WW, Davies BJ, Tarin T, Sweeney DD, Chancellor MB. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol. 2004 Oct; 172(4 Pt 1): 1379-81. 4. Scarpero HM, Dmochowski RR, Nitti VW. Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. J Urol. 2003 Mar; 169(3): 1013-6. 5. Palma PC, Dambros M, Riccetto CL, Thiel M, Netto Junior NR. Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. Actas Urol Esp. 2005 Feb; 29(2): 207-11. Spanish. 6. Petrou SP, Brown JA, Blaivas JG. Suprameatal transvaginal urethrolysis. J Urol. 1999 Apr; 161(4): 1268-71. 7. McCrery R. Transvaginal urethrolysis for obstruction after antiincontinence surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2006 Oct; Epub ahead of print. 8. Petrou SP, Young PR. Rate of recurrent stress urinary incontinence after retropubic urethrolysis. J Urol. 2002 Feb; 167(2 Pt 1): 613-5. |
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| abstract |
Purpose: We examined long-term urinary continence rates in patients after midline simple sling incision for urinary retention following suburethral fascia lata slings. Materials and Methods: A retrospective review was completed of 13 women undergoing a simple sling incision for catheter dependent obstruction after suburethral sling surgery more than 4 years previously. Urinary continence was evaluated by use of the Groutz-Blaivas anti-incontinence surgery response score. The scores were statistically compared as binary categories at mean 111-day and 60.8-month followup. Results: A total of 13 women underwent a simple sling incision for catheter dependent urinary retention after sling surgery, and 11 patients (mean age 73.4 years) were available for long-term followup (60.8 months). The simple sling incision procedure was completed an average of 65 days (range 36 to 235) after original sling placement. Mean post-void residual urine volume at least 1 month after sling surgery was 289 ml (range 75 to 500)............... |
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李主任的文章果然精彩， 除了介紹文章， 也有精彩的評論。 筆者很贊同您的處理流程， 非常值得參考！！ |
2007/2/28 上午 12:11:56 |