从病因治疗到重塑尿控——女性压力性尿失禁的手术治疗观念变更及当前的金标准术式（“大家泌尿网”观看手术视频）

Evolution of surgical treatment for female SUI and the current gold standard: conceptual shift from treatment of etiology to reshape of urinary control mechanism

摘要

女性压力性尿失禁（SUI）发病率高，严重影响患者生活质量，给患者、家庭和社会带来了沉重的经济负担。随着SUI的手术方式及发病机制研究的不断更新，近来关于尿失禁的手术治疗机制，人们的观念已从病因治疗机制转变为重塑尿控机制。因此，自术式微创、效果明确的无张力尿道中段悬吊术（MUS）问世以来，很快被国内外学界公认为是SUI手术治疗的金标准并广泛推广应用。MUS也是四川大学华西医院泌尿外科最常用于SUI患者治疗的手术方式。因此，笔者结合本中心的手术经验，就MUS手术的主要步骤、技术要点以及手术并发症处理与预防策略进行分析，以期为临床提供参考。

Abstract

With the growing aging population, female stress urinary incontinence (SUI), due to its high incidence, has become a common disease that seriously affects patients' quality of life and brings heavy economic burden to families and society. Over the past century, the surgical treatments of SUI were continuously updated along with the in-depth research on the disease mechanism. However, in recent years, the concept of anti-incontinence surgery has shifted from treating the causes to reshaping the urinary control mechanism. As a result, the mid-urethral sling (MUS) procedure has gained global acceptance since its introduction, swiftly acknowledged both domestically and internationally as the gold standard due to its minimally invasive nature and proven effectiveness. MUS is also the most commonly used surgical method for SUI patients treated in our center. Based on our own surgical experience, we will analyze the main steps, technical points, and preventive strategies of surgical complications of MUS, so as to provide clinical reference.

关键词

女性压力性尿失禁 / 手术治疗 / 手术演变 / 无张力尿道中段悬吊术

Key words

female stress urinary incontinence / surgical treatment / evolution of surgical methods / mid-urethral sling

参考文献

[1] 毕文浩， 蒋立城. 女性压力性尿失禁的诊治进展[J]. 山东医药， 2022， 62（16）: 112-115.

[2] ZHANG L, ZHU L, XU T, et al. A Population-based survey of the prevalence, potential risk factors, and symptom-specific bother of lower urinary tract symptoms in adult chinese women[J]. Eur Urol, 2015, 68(1): 97-112.

[3] SCHREINER G, BELTRAN R, LOCKWOOD G, et al. A timeline of female stress urinary incontinence: how technology defined theory and advanced treatment[J]. Neurourol Urodyn, 2020, 39(6): 1862-1867.

[4] 赵桂君， 鞠蕊， 汪红英. 女性压力性尿失禁的研究进展[J]. 中国当代医药， 2022， 29（5）: 32-37.

[5] FRITEL X, PIGNÉ A. Anterior repair using Bologna procedure: long-term results on stress urinary continence[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2002, 13(3): 176-181.

[6] COLLINS SA. Surgical management of stress incontinence[J]. Clin Obstet Gynecol, 2021, 64(2): 297-305.

[7] ITKONEN FREITAS AM, RAHKOLA-SOISALO P, MIKKOLA TS, et al. Current treatments for female primary stress urinary incontinence[J]. Climacteric, 2019, 22(3): 263-269.

[8] BODELL DM, LEACH GE. Needle suspension procedures for female incontinence[J]. Urol Clin North Am, 2002, 29(3): 575-584.

[9] 杨檬. 女性压力性尿失禁的治疗进展[J]. 海南医学， 2022， 33（17）: 2284-2287.

[10] MOHAMMED A, KHAN A, SHAIKH T, et al. The artificial urinary sphincter[J]. Expert Rev Med Devices, 2007, 4(4): 567-575.

[11] PLAGAKIS S, TSEV E. The autologous pubovaginal fascial sling: an update in 2019[J]. Low Urin Tract Symptoms, 2020, 12(1): 2-7.

[12] CHEN J, LI B, PENG L, et al. Autologous pubovaginal sling for recurrent stress urinary incontinence after two or more failed synthetic midurethral sling[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 272: 213-216.

[13] ULMSTEN U, PETROS P. Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence[J]. Scand J Urol Nephrol, 1995, 29(1): 75-82.

[14] FORD AA, ROGERSON L, CODY JD, et al. Mid-urethral sling operations for stress urinary incontinence in women[J]. Cochrane Database Syst Rev, 2017, 7(7): CD006375.

[15] DELORME E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women[J]. Prog Urol, 2001, 11(6): 1306-1313.

[16] DE LEVAL J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out[J]. Eur Urol, 2003, 44(6): 724-730.

[17] MOSTAFA A, LIM CP, HOPPER L, et al. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications[J]. Eur Urol, 2014, 65(2): 402-427.

[18] ZACCHE M, MUKHOPADHYAY S, GIARENIS I. Changing surgical trends for female stress urinary incontinence in England[J]. Int Urogynecol J, 2019, 30(2): 203-209.

[19] ABOUZEID B, EL HASBANI G, MUFARRIJ I. Observational analysis of mesh related complications in urogynecologic procedures[J]. J Robot Surg, 2020, 14(3): 377-382.

[20] FUSCO F, ABDEL-FATTAH M, CHAPPLE CR, et al. Updated systematic review and Meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence[J]. Eur Urol, 2017, 72(4): 567-591.

[21] CHEN Y, ZHANG C, YANG S, et al. Long-term outcomes of surgical interventions for stress urinary incontinence: a systematic review and network meta-analysis[J]. Int J Surg, 2024, 110(1): 520-528.

[22] FORD AA, OGAH JA. Retropubic or transobturator mid-urethral slings for intrinsic sphincter deficiency-related stress urinary incontinence in women: a systematic review and meta-analysis[J]. Int Urogynecol J, 2016, 27(1): 19-28.

[23] TRABUCO EC, CARRANZA D, EL NASHAR SA, et al. Reoperation for urinary incontinence after retropubic and transobturator sling procedures[J]. Obstet Gynecol, 2019, 134(2): 333-342.

[24] PALOS CC, MATURANA AP, GHERSEL FR, et al. Prospective and randomized clinical trial comparing transobturator versus retropubic sling in terms of efficacy and safety[J]. Int Urogynecol J, 2018, 29(1): 29-35.

[25] SERATI M, GHEZZI F, CATTONI E, et al. Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10-year follow-up[J]. Eur Urol, 2012, 61(5): 939-946.

[26] STANFORD EJ, PARAISO MF. A comprehensive review of suburethral sling procedure complications[J]. J Minim Invasive Gynecol, 2008, 15(2): 132-145.

[27] STEPP KJ, BARBER MD, YOO EH, et al. Incidence of perioperative complications of urogynecologic surgery in elderly women[J]. Am J Obstet Gynecol, 2005, 192(5): 1630-1636.

[28] 中国医促会泌尿健康促进分会， 中国研究型医院学会泌尿外科学专业委员会. 女性压力性尿失禁手术安全共识[J]. 现代泌尿外科杂志， 2019， 24（8）: 605-613.

[29] 李旭东， 杜岳峰， 刘润明， 等. 女性压力性尿失禁术前评估及术后并发症处理:西安交通大学第一附属医院经验（“大家泌尿网”观看手术视频）[J]. 现代泌尿外科杂志， 2022， 27（9）: 711-714.

[30] GELLER EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery[J]. Int J Womens Health, 2014, 6: 829-838.

[31] MANGIR N, ROMAN S, CHAPPLE CR, et al. Complications related to use of mesh implants in surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation?[J]. World J Urol, 2020, 38(1): 73-80.

[32] BERGERSEN A, HINKEL C, FUNK J, et al. Management of vaginal mesh exposure: a systematic review[J]. Arab J Urol, 2019, 17(1): 40-48.

[33] ROCKEFELLER NF, PETERSEN TR, JEPPSON PC, et al. Midurethral sling removal or revision in women with chronic pain[J]. Female Pelvic Med Reconstr Surg, 2022, 28(5): e149-e153.

[34] MACDONALD S, TERLECKI R, COSTANTINI E, et al. Complications of transvaginal mesh for pelvic organ prolapse and stress urinary incontinence: tips for prevention, recognition, and management[J]. Eur Urol Focus, 2016, 2(3): 260-267.