Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women
Tóm tắt
We aim to determine the presentation of and immediate and longer-term outcomes of vaginal surgical excision of urethral extrusion of mid-urethral tape (MUT). We performed a retrospective analysis of all patients with urethral extrusion of MUT having vaginal surgical excision between 2007 and 2018. The MUT was removed either partially (via vaginal approach) or completely (via combined vaginal and laparoscopic approach). Functional outcomes and any re-interventions are described. Thirty-four patients of median age 53 (range 34–82) years were identified. Preoperative symptomatic recurrent/persistent urinary incontinence was present in 29/34(85%) with 24/34(71%) women having recurrent/persistent stress urinary incontinence (SUI) or stress predominant mixed urinary incontinence (s-MUI) on urodynamics. Vaginal surgical excision was performed alone in 33/34(97%) women and in combination with laparoscopic removal of abdominopelvic MUT in 1/34(3%) woman. In the longer term vaginal/urethral pain resolved or improved in all 15/15(100%) patients presenting with this complaint whilst patient reported poor flow resolved in 8/9 (89%) women. Twenty-eight of 34 women (82%) had persistent/recurrent SUI or s-MUI following MUT excision. Twenty-four of 34 women (71%) had further SUI surgery with cure or improvement of SUI in 20/24 (83%) patients. The outcome of vaginal surgical excision of the MUT was cure or improvement of pain in 100% and resolution of poor flow in 89% women. Recurrent/persistent SUI or s-MUI was present in 82% following removal as compared to 71% women prior to removal. Of the 71% of women electing to have further surgery for recurrent/persistent SUI/s-MUI, 83% were dry or improved afterwards.
Tài liệu tham khảo
Cashman S, Biers S, Greenwell T, et al. Results of the British Association of Urological Surgeons female stress urinary incontinence procedures outcomes audit 2014-2017. BJU Int. 2019;123:149–59. https://doi.org/10.1111/bju.14541.
Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017. https://doi.org/10.1002/14651858.CD006375.pub4.
Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066–76. https://doi.org/10.1056/NEJMoa0912658.
Viereck V, Rautenberg O, Kociszewski J, et al. Midurethral sling incision: indications and outcomes. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24:645–53. https://doi.org/10.1007/s00192-012-1895-8.
Jonsson Funk M, Siddiqui NY, Pate V, et al. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73.e1–7. https://doi.org/10.1016/j.ajog.2012.10.006.
Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75. https://doi.org/10.1001/jamasurg.2015.2590.
Baracat F, Mitre AI, Kanashiro H, Montellato NID. Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. Clinics (Sao Paulo). 2005;60:397–400. https://doi.org/10.1590/s1807-59322005000500008.
Sergouniotis F, Jarlshammar B, Larsson P-G. Urethral complications after tension-free vaginal tape procedures: a surgical management case series. World J Nephrol. 2015;4:396–405. https://doi.org/10.5527/wjn.v4.i3.396.
Blaivas JG, Olsson CA. Stress incontinence: classification and surgical approach. J Urol. 1988;139:727–31. https://doi.org/10.1016/S0022-5347(17)42611-5.
Wilson A, Pillay S, Greenwell T. How and why to take a Martius labial interposition flap in female urology. Transl Androl Urol. 2017;6:S81–7.
Greenwell T, Cutner A. The anatomy and an illustrated description of a technique for combined laparoscopic and vaginal total removal of an obturator mid urethral tape. Transl Androl Urol. 2018;7:978–81. https://doi.org/10.21037/tau.2018.10.05.
Kim JH, Doo SW, Yang WJ, Song YS. Laparoscopic transvesical excision and reconstruction in the management of mid-urethral tape mesh erosion and stones around the bladder neck: initial experiences. BJU Int. 2012;110:E1009–13. https://doi.org/10.1111/j.1464-410X.2012.11563.x.
Abrams P, Avery K, Gardener N, Donovan J. The international consultation on incontinence modular questionnaire: www.iciq.net. J Urol. 2006;175:1063–6. https://doi.org/10.1016/S0022-5347(05)00348-4.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255:922–8. https://doi.org/10.1097/SLA.0b013e31824f1c21.
Rogers RG, Coates KW, Kammerer-Doak D, et al. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J. 2003;14:164–8. https://doi.org/10.1007/s00192-003-1063-2.
Carlsson AM. Assessment of chronic pain. I Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16:87–101. https://doi.org/10.1016/0304-3959(83)90088-X.
Gomes CM, Carvalho FL, Bellucci CHS, et al. Update on complications of synthetic suburethral slings. Int. Braz J Urol. 2017;43:822–34.
Deng DY, Rutman M, Raz S, Rodriguez LV. Presentation and management of major complications of midurethral slings: are complications under-reported? Neurourol Urodyn. 2007;26:46–52. https://doi.org/10.1002/nau.20357.
Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72–7. https://doi.org/10.1034/j.1600-0412.2002.810113.x.
Osborn DJ, Dmochowski RR, Harris CJ, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;21:1167–70. https://doi.org/10.1111/iju.12544.
Chevrot A, Droupy S, Coffin G, et al. Long-term efficacy and safety of tension free vaginal tape in a historic cohort of 463 women with stress urinary incontinence. Int Urogynecol J. 2017;28:827–33. https://doi.org/10.1007/s00192-016-3230-2.
Lee D, Bacsu C, Dillon B, et al. Complications following the insertion of two synthetic mid-urethral slings and subsequent removal. LUTS Low Urin Tract Symptoms. 2018;10:259–65. https://doi.org/10.1111/luts.12175.
Malde S, Spilotros M, Wilson A, et al. The uses and outcomes of the Martius fat pad in female urology. World J Urol. 2017;35:473–8. https://doi.org/10.1007/s00345-016-1887-2.