Comparing postoperative voiding dysfunction after mid-urethral sling using either a Babcock or Kelly clamp tensioning technique.

Autor: Chang OH; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Hacker MR; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Rosenblatt PL; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.; Department of Obstetrics and Gynecology, Mount Auburn Hospital, 725 Concord Avenue, Suite 1200, Cambridge, MA, 02138, USA., Neo D; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA., Von Bargen E; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.; Department of Obstetrics and Gynecology, Mount Auburn Hospital, 725 Concord Avenue, Suite 1200, Cambridge, MA, 02138, USA., Berrahou I; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Le A; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Lefevre R; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Hota LS; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA. lhota@mah.harvard.edu.; Department of Obstetrics and Gynecology, Mount Auburn Hospital, 725 Concord Avenue, Suite 1200, Cambridge, MA, 02138, USA. lhota@mah.harvard.edu.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2019 Feb; Vol. 30 (2), pp. 301-305. Date of Electronic Publication: 2018 Mar 29.
DOI: 10.1007/s00192-018-3638-y
Abstrakt: Introduction and Hypothesis: The objective was to compare postoperative urinary retention using the Babcock and Kelly clamps for retropubic midurethral sling (RPS) tensioning.
Methods: This was a retrospective cohort of isolated RPS procedures from December 2010 through April 2016 by five fellowship-trained surgeons at two institutions. Slings were tensioned with a Babcock clamp by grasping a 3-mm midline fold of mesh (RPS-B) or a Kelly clamp as a spacer between the sling and suburethral tissue (RPS-K). Assessment of urinary retention included the primary outcome of postoperative catheterization and several secondary outcomes, including discharge home with a catheter, within 1 year of surgery. Analysis of covariance was used to compute the mean difference in duration of catheterization and log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI).
Results: We included 240 patients. The RPS-B group had a lower body mass index and was more likely to be menopausal, have had pelvic organ prolapse surgery, and have a lower maximum urethral closure pressure than the RPS-K group. The mean duration of catheterization was similar, as demonstrated by the crude (0.21 days [-0.30-0.71]) and BMI-adjusted (0.07 days [-0.41-0.55]) mean difference in duration of catheterization. The incidence of postoperative OAB symptoms was comparable between the groups (BMI-adjusted RR: 0.95 (0.80-1.1)), and the incidence of revision did not differ (p = 0.7).
Conclusions: The Babcock and Kelly clamp tensioning techniques appear comparable, with a low incidence of prolonged postoperative catheterization. Most catheters were removed on the day of the surgery. It is reasonable to tension retropubic midurethral slings with either method.
Databáze: MEDLINE
Externí odkaz: