简易悬吊术治疗男性尿失禁

Simple suspension for treatment of male urinary incontinence

目的探讨简易悬吊术治疗男性尿失禁的疗效。方法2000年10月—2009年7月上海交通大学附属第六人民医院收治的男性获得性尿失禁患者44例,其中前列腺术后34例,后尿道手术后10例;完全性尿失禁11例,压力性尿失禁33例,每人需尿布1～5块/d,平均(3±1)块/d。43例行心脏涤纶补片和尼龙线+经阴道无张力尿道中段悬吊(TVT)吊带球部尿道复合悬吊术,1例采用经闭孔途径球部尿道悬吊术。结果随访6～90个月,平均为(52±30)个月。术后初期治愈35例,尿失禁改善7例,手术失败2例,总有效率为95.4%(42/44)。术后随访1年以上患者的总有效率为90.0%(36/40),2例分别在术后1年和2年复发。1例采用经闭孔途径球部尿道悬吊术的患者术后随访6个月,能完全控尿,无残余尿。结论球部尿道悬吊术是治疗男性尿失禁简单而有效的方法。

Objective To evaluate the efficacy of simple suspension in treatment of male urinary incontinence（UI）.Methods From Oct. 2000 to Jul. 2009, 44 patients with acquired UI underwent surgical treatment in our hospital. Thiry-four patients were due to prostatectomy and 10 were due to posterior urethroplasty for urethral stricture. Pre-operatively, 11 patients had complete UI and 33 patients had stress UI, needing 1-5 urinary pads （a mean of [3±1] pads） daily. Forty-three patients received bulbourethral composite sling using a polyester patch plus tension free vaginal tape, and the rest received transobturator bulbourethral sling （TOBS）. Results The patients were followed up for 6-90 months （a mean of [52±30] months）, and complete urinary continence was achieved in 34 patients, improvement in 7 cases, and failure in 2, with a total effective rate of 95.4% （42/44）. One year follow-up showed the total effective rate was 90.0% （36/40）. One case had recurrence one year later and one had recurrence two year later. The patient underwent TOBS was followed up for 6 months and achieved complete urinary continence with no residual urine.Conclusion Bulbourethral sling procedure is a mini-invasive, safe, effective surgical procedure for the treatment of male acquired UI.