Vaginal Laceration and Exposure of Mesh Resulting from Transobturator Vaginal Tape Operation

TVTO對婦女壓力性尿失禁，有較高的主觀及客觀的治療率，與較低的手術後併發症，於最近的研究文獻皆有報導。我們發現一個非常不尋常的TVTO手術案例與大家分享，有－58歲婦女病患，已經做過子宮切除手術多年，並且有嚴重的陰道壁萎縮。經尿動力檢查發現有嚴重的壓力尿失禁，於TVTO手術過程發現有陰道裂傷及吊帶移位，經過重置吊帶及陰道壁修補後，手術後情況良好，無併發症發生。故建議於施行TVTO手術時，發現病患有因停經後之陰道壁萎縮，必須藉以手指端來確定坐骨孔，以避免吊帶移位之發牛。

關鍵字

經坐骨孔陰道無張力吊帶；陰道無張力吊帶；應力性尿失禁

並列摘要

Background and Purpose: The transobturator vaginal tape inside-out (TVT-O) operation is associated with high objective and subjective cure rates for stress urinary incontinence with low incidence of post-operative complications and confirms the results reported in the current Literature. We present an unusual case of vaginal laceration and displacement of mesh during TVT-O operation procedure due to severe atrophic vaginal mucosa and discuss the management and the outcome of urinary continence. Methods: A 56-year-old woman, with a impression of stress urinary incontinence. The patient had a history of previous vaginal hysterectomy and now with severe vaginal atrophy wais found. Results: Vaginal laceration was noted after application of TVT-O, and cystoscopy revealed no bladder perforation. Mesh displacement beneath internal edge of obturator foramen was also noted. Removed the displaced mesh and reinserted the mesh by identifying internal edge of obturator foramen was performed carefully. Conclusion: Vaginal laceration and displacement of mesh is an unusual complication during TVT-O operation procedure. However, when vaginal epithelium is too severe atrophic to dissect off underlying periurethral fascia. We need to perform vaginal dissection carefully and introduce fingertip to identify internal edge of obturator foramen during passage of the tap through it.

並列關鍵字

transobturator vaginal tape inside-out ； TVT-O ； tension-free vaginal tape ； TVT ； urodynamic stress incontinence

國際替代計量

Vaginal Laceration and Exposure of Mesh Resulting from Transobturator Vaginal Tape Operation

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