Nguyen H T, Bauer S B, Diamond D A, Retik A B
Department of Urology, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2001 Aug;166(2):658-61.
While a fascial sling for treating children with intractable urinary incontinence is often successful in girls, its effectiveness in boys remains unclear. We determined the long-term efficacy of a rectus fascial sling in boys with neurogenic sphincteric incontinence and defined its urodynamic characteristics for achieving continence.
We reviewed the charts of all boys who underwent a rectus fascial sling procedure for neurogenic incontinence to determine urinary continence status at the most recent office visit or by telephone interview, the type and dose of anticholinergic and sympathomimetic medications, the frequency of intermittent clean intermittent catheterization, status of the upper urinary tract and comparative urodynamic findings preoperatively and postoperatively.
We evaluated 7 boys 7 to 19 years old, of whom 4 were postpubertal, who fulfilled study criteria and had a followup of 1 to 9 years. In 4 patients a continent stoma was created concurrently at surgery. Postoperatively all patients were dry during the first 3 months after surgery. At the last followup 1 patient was completely dry, 3 had occasional nighttime wetting, 2 had occasional stress incontinence, and 1 had frequent daytime and nighttime wetting requiring subsequent bladder neck closure. Prepubertal and postpubertal males performed catheterization without difficulty and all required less frequent clean intermittent catheterization and medication postoperatively compared to preoperative status. None had hydronephrosis. Postoperatively urodynamic evaluation revealed normal bladder compliance, improved urethral resistance that did not decay with bladder filling and no uninhibited contractions.
The rectus fascial sling is effective for increasing bladder outlet resistance and decreasing the degree of incontinence in prepubertal and postpubertal males with neurogenic sphincteric incontinence. It has no long-term deleterious effects on bladder function and does not impair the ability to catheterize postoperatively. A fascial sling is an effective alternative to bladder neck closure when creating a continent stoma.
虽然筋膜吊带治疗顽固性尿失禁的女童往往很成功，但其对男童的有效性仍不明确。我们确定了腹直肌筋膜吊带治疗神经源性括约肌失禁男童的长期疗效，并明确了其实现控尿的尿动力学特征。
我们回顾了所有因神经源性尿失禁接受腹直肌筋膜吊带手术的男童病历，以确定在最近一次门诊就诊或通过电话访谈时的尿失禁状况、抗胆碱能和拟交感神经药物的类型及剂量、间歇性清洁导尿的频率、上尿路状况以及术前和术后的尿动力学比较结果。
我们评估了7名7至19岁的男童，其中4名已进入青春期后期，他们符合研究标准，随访时间为1至9年。4例患者在手术时同时创建了可控造口。术后所有患者在术后前3个月均无尿失禁。在最后一次随访时，1例患者完全无尿失禁，3例偶尔夜间遗尿，2例偶尔出现压力性尿失禁，1例白天和夜间频繁遗尿，随后需要进行膀胱颈闭合术。青春期前和青春期后的男性导尿均无困难，与术前相比，术后所有患者均需要更少频率的间歇性清洁导尿和药物治疗。无人患有肾积水。术后尿动力学评估显示膀胱顺应性正常，尿道阻力改善，且不会随膀胱充盈而下降，也无无抑制性收缩。
腹直肌筋膜吊带对于增加青春期前和青春期后患有神经源性括约肌失禁男性的膀胱出口阻力及降低尿失禁程度有效。它对膀胱功能无长期有害影响，且不损害术后导尿能力。在创建可控造口时，筋膜吊带是膀胱颈闭合术的有效替代方法。
