Madjar S, Jacoby K, Giberti C, Wald M, Halachmi S, Issaq E, Moskovitz B, Beyar M, Nativ O
Bnai-Zion Medical Center, Haifa, Israel, Northwest Hospital, Seattle, Washington, and San Paolo Hospital, Savona, Italy.
J Urol. 2001 Jan;165(1):72-6. doi: 10.1097/00005392-200101000-00018.
This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence.
A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure.
Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications.
This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence.
本项正在进行的研究评估一种新型微创吊带手术治疗前列腺切除术后尿失禁的安全性和有效性。
共有16名年龄在56至74岁（平均年龄67岁）的男性接受了使用直入式骨锚定系统的手术。前列腺切除术后时间为1.5至5年（平均2.5年）。16例患者中，14例经尿动力学证实为压力性尿失禁，2例为压力性尿失禁合并逼尿肌不稳定的混合性尿失禁。手术采用会阴入路，患者取截石位。将4枚预先连接1号聚丙烯缝线对的微型骨螺钉直接置入耻骨下支内侧。每侧在耻骨联合下方置入一对骨锚，第二对骨锚在其下方3至4厘米处插入。为了支撑球部尿道，使用连接到骨锚的4对缝线将明胶包被的聚对苯二甲酸乙二酯梯形吊带或尸体阔筋膜 lata 系于耻骨。尿道阻力增加至比基线压力高30至50厘米水柱。
随访时间为4至20个月（平均12.2个月）。术前经尿动力学诊断为真性压力性尿失禁的14名男性中，12例尿失禁治愈，定义为自觉干爽，无需使用或仅每日使用1片护垫以防漏尿，且无任何漏尿发作；2例主观症状改善，每日使用护垫减少50%或更多。另外2例术前诊断为混合性尿失禁的患者症状改善。这些患者术后尿动力学研究显示压力性尿失禁消失，但持续性急迫性尿失禁仍存在。他们对抗胆碱能药物有反应，且完全干爽。术中及术后并发症极少，无侵蚀、感染或骨并发症。
这种新型微创男性吊带手术安全有效。通过测量尿道阻力调整吊带张力可降低过度矫正和失败率。需要更多经验来确立该手术作为前列腺切除术后尿失禁的治疗方法。
