盆底肌悬吊术治疗女性尿道下裂合并排尿困难

Treatment of female hypospadias with dysuria by pelvic floor suspension

目的探讨女性尿道下裂患儿合并排尿困难、尿失禁的原因,并寻找合适的治疗方法。方法总结11例排尿困难、尿失禁而同时合并有尿道下裂的女性病例,接受髂腰肌转移盆底肌悬吊术治疗。结果11例术后随访6～30个月,平均18个月,控尿满意(昼夜均能保持3 h以上完全干燥)7例。好转(部分控尿,白天偶有尿失禁或夜间尿床)3例,无效(症状无改善)1例,总有效率为90.9%。术前最大膀胱容量(162.5±69.8)ml、漏点压(33.4±7.5)cmH_2O(1 cmH_2O=0.098 kPa)、最大尿道压(37.4±12.7)cmH_1O、最大关闭压(23.8±12.2)cmH_2O、功能尿道长度(2.4±1.6)cm;残余尿(93±56)ml;术后分别为(201.6±62.3)ml、(49.8±15.4)cmH_2O、(52.8±14.3)cmH_10、(32.8±11.6)cmH_2O、(3.6±2.0)cm,(25±20)ml,均较术前明显改善(P<0.01)。泌尿系感染频率和程度较治疗前明显减少和减轻。结论髂腰肌转移盆底肌悬吊术可以作为女性尿道下裂合并尿失禁、排尿困难的可供选择的治疗方法。

Objective To evaluate the results of pelvic floor suspension for female hypospadias with dysuria. Methods There were 11 cases of female hypospadias with dysuria treated by pelvic floor suspension combined with iliac lumbar muscle transfer. The long-term results including symptoms and urodynamic examination were recorded and analyzed in these patients. Results All patients were followed up for 6 to 30 months （mean 18 months）. Seven cases achieved continence, 3 cases were improved, and the other 1 failed to get better. The overall effective rate was 90%. Preoperatively, the maximum bladder volume was （162. 5 ± 69. 81 ）ml, leak point pressure was （33.4 ± 7.5）cm H2O, maximum urethral pressure was （37.4 ± 12.7） cm H2O, maximum closing pressure was （23. 8± 12. 2） cm H2O, functional urethral length was （2.4± 1.6）cm, and residual urine was （93 ± 56） ml, respectively. Postoperatively, they were （201.6 ± 62. 3 ） ml, （49. 8 ± 15. 4） cm H2O, （ 52. 8 ± 14. 3 ） cm H2O, （32. 8± 11.6）cm H2O, （3.6 ± 2. 0）cm, and （25 ± 20）ml, correspondingly. The differences were significant （P〈0. 01 ）. The frequency and extent of the urinary infection were decreased and alleviated remarkably. Conclusions Pelvic floor suspension with iliac lumbar muscle transfer may become a better method to treat the female hypospadias with dysuria.