Ferrer F A, Tadros Y E, Gearhart J
Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Urology. 2001 Nov;58(5):791-6. doi: 10.1016/s0090-4295(01)01345-0.
The modern Young-Dees-Leadbetter bladder neck reconstruction is a procedure that has evolved during the past 82 years. During this time, the modifications and contributions of several urologic surgeons have improved the procedure and ultimate patient outcomes. We review the evolution and describe in detail our version of the Young-Dees-Leadbetter bladder neck reconstruction procedure.
Optimally, patients should have a minimal bladder capacity of 85 mL and be mature enough to participate in a postoperative voiding program. Adequate radical exposure of the lateral aspects of the bladder and bladder neck are important. Cephalotrigonal or cross-trigonal ureteral reimplantation is typically performed to mobilize the ureters in relation to the proposed bladder neck and correct reflux. A mucosal template 15 mm wide by 30 mm long is created that will serve as the reconstituted posterior urethra and bladder neck. Triangular lateral bladder mucosal wedges are marked and demucosalized. The neourethra is closed over an 8F Firlit tube. The demucosalized flaps are brought over the urethra sequentially in a "vest-over-pants" fashion with the final layer consisting of suspension sutures. Finally, ureteral stents and a suprapubic tube are used, but no urethral catheter is left in place.
The modern Young-Dees-Leadbetter bladder neck reconstruction is the result of the contributions of various urologic surgeons during 82 years. When patients are appropriately selected, it is an effective method of lower urinary tract reconstruction in cases of congenital urinary incontinence.
现代的扬-迪斯-利德贝特膀胱颈重建术是在过去82年中不断发展的一种手术。在此期间，几位泌尿外科医生的改进和贡献提升了该手术及最终的患者治疗效果。我们回顾其发展历程，并详细描述我们版本的扬-迪斯-利德贝特膀胱颈重建手术。
理想情况下，患者的膀胱容量应至少为85毫升，且足够成熟以参与术后排尿计划。充分彻底暴露膀胱和膀胱颈的外侧很重要。通常进行头侧三角区或交叉三角区输尿管再植术，以便在拟重建的膀胱颈周围游离输尿管并纠正反流。制作一个宽15毫米、长30毫米的黏膜模板，它将作为重建的后尿道和膀胱颈。标记并去除膀胱外侧的三角形黏膜楔形组织。新尿道在一根8F弗利特导管上闭合。去黏膜化的皮瓣以“背心套裤子”的方式依次覆盖在尿道上，最后一层为悬吊缝线。最后，使用输尿管支架和耻骨上导尿管，但不留置尿道导管。
现代的扬-迪斯-利德贝特膀胱颈重建术是82年来各位泌尿外科医生贡献的成果。当患者选择适当时，它是先天性尿失禁病例中一种有效的下尿路重建方法。
