改良膀胱颈重建术治疗括约肌功能障碍性尿失禁的疗效观察

Modified bladder neck reconstruction for the treatment of urinary incontinence due to the sphincter dysfunction

目的探讨采用改良膀胱颈重建术治疗括约肌功能障碍性尿失禁的疗效。方法2010年1月至2014年12月采用改良膀胱颈重建术治疗23例括约肌功能障碍性尿失禁患者，男16例，女7例。年龄17—61岁，平均36岁。病因为外伤性骨盆骨折尿道断裂术后尿失禁19例，其他手术后尿失禁4例。尿失禁病史1—5年，平均2年。尿动力学检查示最大尿道压21～43cmH2O（1cmH2O=0．098kPa），平均34cmH2O。23例均于全麻下行改良膀胱颈重建术，术中纵行切开膀胱，保留三角区膀胱颈到输尿管开口前宽2．0或2．5cm的黏膜，将三角区其余部位以电凝方法去黏膜化。以14—16F导尿管为支架，用2-0或3-0可吸收线将三角区肌肉组织做多层间断缝合形成新的膀胱颈和后尿道。在新建的后尿道和重建的膀胱颈上方连续缝合膀胱前壁，关闭膀胱。结果本组23例术后随访6个月～3年，达到完全控尿5例，其中2例术后排尿困难，经再次留置尿管2周后排尿通畅；达到社会控尿9例；控尿改善7例；失败2例。4例术后行尿动力学检查，最大尿道压为52—72cmH2O，平均64cmH2O。结论改良膀胱颈重建术是一种治疗括约肌功能障碍性尿失禁较好的术式，尤其是对男性外伤性尿道狭窄或其他手术后尿失禁较为适合。

Objective To explore the outcome of modified bladder neck reconstruction in treating the urinary incontinence due to the sphincter dysfunction. Methods Between January 2010 and December 2014,a total of 23 patients, including 16 male and 7 female cases, with incontinence due to sphincter dysfunction had undergone a procedure of modified bladder neck reconstruction. The mean age was 36 years （range 17 - 61 years ）. Etiology of incontinence was secondary to pelvic fracture and urethral rupture procedure in 19 patients and other failure procedures in 4 cases. The mean duration of incontinence was 2 years （range 1 -5 years）. Urodynamic examination was performed in all patients and the mean maximum urethral pressure was 34 cmH2O （range 21 -43 cmH2O ）. The modified bladder neck reconstruction was performed in 23 patients. Under the general anesthesia and vertical bladder ineision, triangular mucosal strips, from the bladder neck to ureteral office, were denuded and leaving the central urethral plate, which was 2. 0 - 2. 5 em in width. In order to form a neourethra and bladder neck, the multilayer triangular muscles were sutured interruptedly over a 14 - 16 F eatheter using 2-0 or 3-0 polyglaetin. And the anterior wall of the bladder was then elosed over the new bladder neck using eontinuous sutured. Results The 23 patients were followed up for 6 months to 3 years, mean 1.4 years. Continence achieved in 5 patients. Of them, 2 patients had diffieuhy in voiding but corrected by indwelling the catheter for another 2 weeks. Social continence was aehieved in 7 patients. Incontinenee status was improved in 7 eases and failed in 2 eases. Urodynamic examination was performed in 4 patients and the mean maximum urethral pressure was 64 cmH2O （ range 52 -72 cmH2O ）. Conclusions Our study suggested that the modified bladder neck reconstruction was a good procedure for the treatment of urinary incontinence due to sphincter dysfunction, particularly for the ineontinenee seeondary to the traumatic urethral stricture or other operation.