Kobashi K C, Mee S L, Leach G E
Tower Urology Institute for Continence and Cedars-Sinai Medical Center, Los Angeles, California, USA.
Urology. 2000 Dec 4;56(6 Suppl 1):9-14. doi: 10.1016/s0090-4295(00)00706-8.
A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.
描述了一种使用尸体阔筋膜通过经阴道途径同时修复膀胱膨出和放置耻骨后阴道吊带的新技术，并报告了我们的早期结果。我们将此称为带吊带的尸体脱垂修复术（CaPS）。50例年龄在37至90岁之间的患者接受了使用单片尸体筋膜同时修复膀胱膨出和经阴道耻骨后阴道吊带的新技术。最大随访时间为6个月（范围1至6个月）。经阴道放置一段6×8cm的尸体阔筋膜，以修复膀胱疝入阴道的缺损，并在膀胱颈/近端尿道提供吊带支撑。吊带通过经阴道骨锚固定在耻骨上。然后，将剩余的筋膜用可吸收缝线双侧固定在提肌/耻骨宫颈筋膜的内侧边缘以及阴道袖口或宫颈处，以减少膀胱膨出。通过术前和术后的压力、排空、解剖结构、保护、不稳定（SEAPI）评分以及基于三级解剖分类系统的脱垂分级对患者进行评估。出现的症状包括压力性尿失禁（SUI）13例（26%）、急迫性尿失禁4例（8%）、混合性尿失禁6例（12%）和盆腔器官脱垂20例（40%）。这些症状并非相互排斥；一些患者表现出多种症状组合。术前平均SEAPI评分为5.51，术后为0.63，有显著改善（P<0.001）。在40例脱垂被量化的患者中，1例（2.5%）有轻度膀胱膨出，16例（40.0%）有中度膀胱膨出，23例（57.5%）有重度膀胱膨出。CaPS术后，36例（72%）完全无尿失禁，3例（6%）仍有持续性SUI，1例（2%）出现新发尿失禁（UI），3例（6%）仍有持续性UI，1例（2%）有混合性尿失禁。无患者发生永久性尿潴留。经阴道放置尸体筋膜用于同时进行吊带和膀胱膨出修复，可为修复提供强度极佳的材料，而无需依赖盆腔器官脱垂患者本身薄弱的组织。到目前为止，CaPS的早期结果非常令人鼓舞。正在进行长期随访以评估该手术的疗效。
