不同术式球部尿道悬吊术治疗男性获得性尿失禁的疗效分析

Analysis of different bulbourethral sling procedurnges for treatment of male acquired urinary incontinence

目的 探讨不同球部尿道悬吊术式治疗男性获得性尿失禁的疗效. 方法 回顾性分析2000年10月至2013年6月105例采用3种不同术式在尿动力监测下行球部尿道悬吊术治疗男性获得性尿失禁患者的资料.患者年龄15～81岁,平均54岁.尿失禁病因分别为前列腺术后70例和后尿道狭窄术后35例.术前完全性尿失禁10例,压力性尿失禁95例.尿失禁病史1～12年,平均3年.术式为复合吊带悬吊54例,经闭孔吊带悬吊41例,带筋膜腹直肌瓣悬吊10例. 结果 本组患者术后随访3～ 128个月,平均54个月.103例于术后第5～7天拔除导尿管,5例出现排尿困难,4例再次留置导尿1周后排尿通畅,1例经膀胱颈部电切后排尿通畅；余2例手术结束时尿道压分别为110和158 cm H2O（1 cm H2O=0.098 kPa）,术后分别留置导尿管2周和3周,拔除导尿管后排尿通畅和完全控尿.本组治愈74例,治愈率为70.5％ （74/105）,其中前列腺术后患者治愈率达81.4％（57/70）,后尿道狭窄术后患者治愈率为48.6％（17/35）；改善26例,无效5例. 结论 尿动力监测下球部尿道悬吊术是治疗男性获得性尿失禁的有效方法,尤其适合前列腺术后尿失禁患者.

Objective To explore the efficacy of different bulbourethral sling procedures in the treatment of male acquired urinary incontinence. Methods A retrospective study of 105 patients with ac- quired urinary incontinence was performed. The patients underwent 3 different bulbourethraI sling procedures under urodynamic monitoring between October 2000 and June 2013. Mean age was 54 years （range 15-81 ）. Urinary incontinence was secondary to post-prostatectomy in 70 patients and posterior urethroplasty in 35. Preoperatively, 10 patients were completely urinary incontinence and 95 patients were stress urinary inconti- nence. Mean duration of urinary incontinence was 3 years （1-12）. The surgical techniques were composite device suspension in 54 patients, pedicled rectus abdominalis muscle and fascial flaps suspension in 10 and transobturator sling in 41. Results The patients were followed up for 3-128 months （mean 54 months）. The urethral catheter was left in situ for 5-7 days in 103 patients. Of the 103 patients, 5 patients were diffi- culty in voiding but corrected by indwelling of urethral tube for another 1 week in 4 patients and transurethral bladder neck resecting in 1. In the remainder 2 patients, the maximum urethral pressure was 110 and 158 cm H20 （ 1 cm H20=0.098 kPa） at the end of surgery and both patients were able to void on day 14 and 21 respec- tively and achieved complete continence. In this study, complete continence was achieved with good voiding in 74 patients （70.5%） , completed control of urination rate was 81.4% （57/70） in group of prostate and 48.6% （17/35） in group of posterior urethroplasty. Twenty-six patients were improved and 5 patients were failed. Conclusion Bulbourethral sling procedure under urodynamic monitoring is an effective option in the treatment of male acquired urinary incontinence, especially for patients of incontinence of post-prostatec- tomy.