Sling plication for failed midurethral sling surgery to treat female stress urinary incontinence

Eva M.P. Remmen, John P.F.A. Heesakkers
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Abstract

Introduction:

Stress urinary incontinence (SUI) is a common problem in women. When conservative therapy fails, surgical interventions should be considered. Midurethral slings (MUSs) were introduced in the 1990s and have been the golden standard for surgical treatment of SUI. Despite being the golden standard among several different surgical options for SUI, failure rates vary from 8% to 57%. There is no defined standard of care after failed MUS. Sling plication is a less invasive procedure compared to other surgical options, however data is relatively scarce.

Methods:

Three women who underwent sling plication for persistent SUI after retropubic MUS were identified. Sling plication was performed by the same physician. The polypropylene sling was isolated and cut medially. Sling ends were then folded over each other and fixated with prolene sutures. Tensioning of the sling was based on the subjective assessment of the surgeon. Subjective and objective findings were collected before initial placement of MUS, after placement of MUS and at six and twelve weeks after plication of MUS.

Results:

All three women had a satisfactory reduction of SUI symptoms after sling plication. Reduction in pad use was clinically relevant, decreasing from two to six large pads to a maximum of two small pads a day. There were no post-operative complications. All women would recommend sling plication to others in the same situation.

Conclusion:

Sling plication is an effective, safe and less invasive way of treating persistent or recurrent SUI after midurethral sling surgery and should be considered when counselling patients after failed MUS. Further research with bigger study populations, standardised methods to quantify improvement after plication and longer follow-up is needed to verify our positive results.
应用吊带治疗女性压力性尿失禁失败的中尿道吊带手术
摘要压力性尿失禁(Stress urinary incontinence, SUI)是女性的常见病。当保守治疗失败时,应考虑手术干预。中尿道吊带术(MUSs)在20世纪90年代被引入,并已成为SUI手术治疗的黄金标准。尽管这是治疗SUI的几种不同手术选择中的黄金标准,但失败率从8%到57%不等。在MUS失败后,没有明确的护理标准。与其他手术选择相比,Sling应用是一种侵入性较小的手术,然而数据相对较少。方法:对3例耻骨后MUS术后持续性SUI行吊带治疗的妇女进行分析。Sling应用是由同一位医生完成的。将聚丙烯吊带隔离,中间切开。然后将吊索两端相互折叠,并用prolene缝线固定。吊带的张力是基于外科医生的主观评估。主观和客观的结果收集在初始放置MUS之前,放置MUS之后,在应用MUS后的第6周和第12周。结果:所有三名妇女在使用吊带后SUI症状都得到了满意的减轻。减少垫的使用与临床相关,从每天2到6个大垫减少到最多2个小垫。无术后并发症。所有女性都会建议其他人在同样的情况下使用sling。结论:应用吊带是治疗尿道中悬吊术后持续或复发性SUI的一种有效、安全、微创的治疗方法,在治疗失败患者时应予以考虑。进一步的研究需要更大的研究人群,标准化的方法来量化应用后的改善和更长时间的随访来验证我们的积极结果。
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