带蒂腹直肌瓣夹压悬吊球部尿道治疗获得性尿失禁的实验研究与临床应用

Pedicled rectus abdominis muscle flap for suspending the bulbar urethra in the treatment of male acquired urinary incontinence: an experimental and clinical study

目的探讨采用带蒂腹直肌瓣夹压悬吊球部尿道治疗男性获得性尿失禁的可行性和有效性。方法取10只成年雄性比格犬带蒂腹直肌,长约8．0 cm,宽约2．5 cm,包绕球部尿道处阴茎1周,术前、术中、术后1个月、2个月分别测定尿道压力变化。临床采用带蒂腹直肌瓣悬吊球部尿道治疗2例男性复杂性尿道狭窄术后压力性尿失禁。结果犬使用腹直肌包绕阴茎后及术后2个月,最大尿道内压分别为(78．3±20．5)cm H2O(1 cm H2O=0,098 kPa)和(88．3±22．4)cm H2O,与术前(48．9±11．0)cm H2O相比差异均有统汁学意义(t=4．995,P=0．0007和t=6．058,P= 0．0002)。临床2例采用带蒂腹直肌瓣悬吊球部尿道术后7 d拔除导尿管,1例排尿通畅,另1例排尿困难,再次留管1周后排尿通畅。术后分别于10个月、1年随访,1例控尿较术前明显改善,另1例完全控尿,术后最大尿流率分别为25 ml／s和34 ml／s。结论采用带蒂腹直肌瓣夹压悬吊球部尿道能明显提高尿道压力,为治疗男性尿失禁增加了一种新的术式。

Objective To investigate the possibility and efficacy of pedicled rectus abdominis musle flap that slings the bulbar urethra for the treatment of male acquired urinary incontinence. Methods Ten adult male Beagles dogs underwent a procedure in which a pedicled rectus abdominis muscle fascial flap （ about 8.0 cm long × 2.5 cm wide） wrapped around the penis at the site of bulbar urethra. Profilometry of the urethral pressure was carried out before, during and after the operation in all dogs. Besides,2 male patients with stress urinary incontinence following posterior urethroplasty of complex pelvic fracture were treated by a pedicled rectus abdominis muscle flap that slung the bulbar urethra in a similar way. Results In experimental canine group ,before operation,the mean maximal urethral pressure （MUP） was （48.9 ± 11.0） cm H2O;and it was （78.3 ±20.5） cm H2O and （88.3 ± 22.4） cm H2O,respectively,after the penis was surrounded by a rectus muscle flap during and 2 months after operation,which were significant higher than that before operation （ t = 4. 995 ,P = 0. 0007 ; t = 6.058, P = 0. 0002 ）. In clinical group, after pedicled rectus sling procedure, 1 patient voided well after removal of the catheter 1 week after operation;the other had diffieulty in voiding on d7 ,and voided very well 13 d after operation. The 2 patients were followed for 10 and 12 months,respectively. Complete continence was achieved in 1 patient,with peak flow rate of 34 ml/s. Incontinence was significantly improved in the other,with peak flow rate of 25 ml/s. Conclusions A pedicled rectus abdominis muscle flap that wraps around the penis or slings the bulbar urethra can raise the urethral pressure and provide a new surgical technique for treating male urinary incontinence.