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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 高育琳 | 手術切除引起併發症的尿失禁吊帶 | 2009/9/25 下午 06:19:55 | 0 |
| 原 文 | 題 目 | Surgical Resection for Suburethral Sling Complications After Treatment for Stress Urinary Incontinence |
| 作 者 | Vincent Misrai, Morgan Rouprêt, Evanguelos Xylinas, Florence Cour, Christophe Vaessen, Alain Haertig, François Richard and Emmanuel Chartier-Kastler | |
| 出 處 | The Journal of Urology 2009, Vol 181(5), 2198-2203 | |
| 出版日期 | May, 2009 | |
| 評 論 |
Suburethral tapes 即是tension-free TVT and/or TOT 已成為婦女尿失禁標準的治療方式。這由 TVT自1996年上市以來，已在全世界施行了120萬個案例及此術式可達80%的成功率可得到證明。相對於這個術式雖然簡單易學，卻仍有些潛在的併發症。所以每個施行這個術式的醫師，都必須了解並掌握移除suburethral tapes的時機及可能性。 這篇論文提供了作者群 ”移除suburethral tapes” 的適應症及手術經驗。這是一篇目前討論這個主題最大series的文章。移除suburethral sling的適應症為 mesh erosion/extrusion (32%)；膀胱出口阻塞(38%)；慢性骨盆疼痛(21%)；術後新生的尿急感 (De novo detrusor overactivity) (8%)。這些適應症是reasonable。至於作者提出利用extraperitoneal laparoscopic approach 來完全移除sling的作法，就比較值得討論。（在文章中作者詳細描述手術方法，值得有興趣的讀者參考）。 一： laparoscopic approach是新的一個術式選擇，就如同我們採取TVT/TOT是個mini-invasive的方法，值得一試。 二：作者偏好採取完全移除（complete resection）suburethral sling的處置，與一般的作法為conservative treatment 或部分切除tapes，就顯得過於積極。但是他們採取 laparoscopic approach可將 vaginal approach的incision及 dissection做些許的修正，以減少病人的suffering。但是作了complete resection of tapes後，約有52%的病人會發生incontinence的機會，是吾人必須術前跟病人討論清楚。 |
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| abstract |
Purpose: Suburethral tapes have been widely adopted to treat stress urinary incontinence. Further resection of such tapes may be necessary in certain cases. We review our experience and assess urinary functional outcomes. Materials and Methods: We retrospectively reviewed the data on all women referred to our institution between 2001 and 2007 for suburethral tape related complications and on those who had the tape surgically removed. Complete or partial resection was achieved after assessment, including endoscopic and urodynamic assessment. Results: A total of 75 women with a mean age of 60.7 years (range 28 to 78) were included in the study. The tape used was transvaginal in 58 cases (77.3%) and transobturator in 17 (22.7%). There were different complications, such as erosion in 16% of cases, vaginal extrusion in 24%, bladder outlet obstruction in 45%, chronic pelvic pain in 21%, and de novo urinary incontinence and urgency in 12%. Resection was done a mean _ SD of 33 _ 22 months (range 6 to 80) after tape placement. Of the 58 women with transvaginal tape the tape was completely removed by laparoscopy in 30 (51%). Four of the 17 transobturator slings (23%) were completely removed by laparoscopy (1) and via a low gynecological approach (3). The remaining slings were partially resected via a gynecological approach. At a mean followup of 38.4 months (range 12 to 72) incontinence recurred in 39 women (52%) after partial (18) and complete (21) resection. Conclusions: In rare women who experience crippling symptoms after suburethral sling implantation urologists must be aware that the decision to completely or partially resect the tape can help resolve symptoms. |
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