尿道压监测下球部尿道悬吊术治疗男性获得性尿失禁

Bulbourethral suspension under urodynamic monitoring for the treatment of male acquired urinary incontinence

目的探讨尿道压监测下球部尿道悬吊术治疗男性获得性尿失禁的疗效。方法2000年lO月至2004年9月收治男性获得性尿失禁25例，年龄18～81岁，平均66岁。其中后尿道狭窄行尿道成形术后6例，根治前列腺切除术后4例，良性前列腺增生（BPH）行经尿道前列腺电切术（TURP）后6例，BPH行前列腺摘除术后9例。尿失禁病程1～12年，平均4年。完全性尿失禁8例，压力性尿失禁17例，需尿垫1～5块／d，平均3块／d。术前均经盆底肌锻炼无效。尿动力学检查平均最大尿道压52cm H2O（1cm H2O=0．098kPa）。平均功能性尿道长度1．4cm。均在尿道压监测下行球部尿道悬吊术。结果手术结束时平均尿道压96cm H2O，平均功能性尿道长度3．5cm。术后完全控尿21例，尿失禁改善3例，排尿困难1例，经膀胱颈部电切后排尿通畅。术后1个月B超检查剩余尿均〈20ml；23例平均最大尿流率15ml／s。随访1年以上22例，1例于术后2年死于脑溢血，2例于术后1年和2年压力性尿失禁复发，其余19例排尿和控尿良好。结论尿道压监测下球部尿道悬吊术是治疗男性尿失禁的有效方法。

Objective To explore whether bulbourethral sling procedure under urodynamic monitoring is effeetive in the treatment of male aequired urinary ineontinenee of post-prostatectomy and posterior urethroplasty. Methods Between October 2000 and September 2004,25 men aged 18 to 81 years （mean age,65 years） with acquired urinary ineontinenee underwent bulbourethral sling procedure, The causes of urinary ineontinenee were as follows： post-radical prostateetomy in 4 patients,TURP for BPH in 6,post-posterior urethroplasty for urethral stricture in 6,and prostatic enueleation for BPH in 9. Preoperatively, 8 patients had completely urinary incontinence and 17 had stress urinary incontinence,with 1 -5 urinary pads （mean, 3 pads） needed per day. All the patients experienced exercise of pelvic floor muscles without results. The mean duration of urinary incontinence was 4 years （range,1 - 12 years）, The mean maximum urethral pressure was 52 cm H2O （range,30 -87 cm H2O,1 cm H2O =0.098 kPa） and mean functional urethral length was 1.4 cm （ range ,0.8 - 2.5 cm）. Results Postoperatively,the mean maximum urethral pressure was 96 cm H2O（ range,85 - 115 cm H2O） and mean functional urethral length was 3.5 cm（ range,3.0 - 4.5 cm）. Complete control of urination was achieved in 21 patients and improved incontinence in 3. Postoperative difficulty in voiding occurred in only 1 patient, but was corrected by transurethral bladder neck excision,resulting in free passage of urine and continence, All patients had 〈 20 ml post-mieturition residual urine within 1 month postoperatively. Uroflowmetry examination of 23 patients showed the mean urinary peak flow of 15 ml/s （range, 12 -19 ml/s） postoperatively. Follow-up of more than 1 year was available in 22 patients,of whom 1 died of cerebral hemorrhage 2 years after operation, and 2 suffered from stress ineontinenee again 1 and 2 years,respectively,after operation. The remaining 19 patients had urination and continence similar to those initially after operation. Conclusions Bulbourethral sling procedure under urodynamic monitoring is an effective method in the treatment of male acquired urinary incontinence.