曾經吊帶手術之患者再接受尿道放鬆手術的長期追蹤
吳書雨、郭漢崇
花蓮慈濟醫院 泌尿科
Longterm outcome in women after anti-incontinence surgery and subsequent transvaginal urethrolysis
Shu-Yu Wu, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan
Purpose: Stress urinary incontinence is a bothersome compliant and commonly encountered in female patients. Once fail conservative management, surgical intervention was indicated. Nowadays, many different suburethral slings are recommended in its treatment. However, sometimes dysuria and even urine retention could happen after operation. This study investigates the long-term result of female patients received pubovaginal sling (PVS) and subsequenct transvaginal urethrolysis.
Materials and Methods: We retrospective reviewed the female patients received PVS and transviginal urethrolysis in Hualien Tzu Chi Hospital over the past two decades. Urodynamic study was performed before and after each operation. The patient global impression of improvement (PGI-I) and quality of life due to urinary symptoms (QoL) from 0 to 6 were used for outcome evaluation.
Results: Total 405 female patients received pubovaginal sling in the past two decades. Only 14 of them (3.5%) received subsequent transvaginal urethrolysis. The main reason was dysuria (100%), followed by urine retention (61.5%) and severe wound discomfort (7.7%). The average age of PVS and urethrolysis were 59.57±6.95 and 60.00±6.97 years. The average interval between two operations was 147.63±353.62 (2～1344) days. Most patients received the two operations within one month (64.3%); only one patient had an operation interval more than one year. The mean follow up time after urethrolysis was 91.14±50.66 months. At follow up, 92.9% patients could maintain continent.
Conclusions: Transvaginal urethrolysis is a rare condition after PVS. Both the bladder function and voiding changed after PVS and resolved after transvaginal urethrolysis. Surprising, even after uretholysis, patients’ symptoms will not return to the baseline situation. Most patients could still reach continent. The patients’ satisfaction was also very well.