Colvert James R, Kropp Bradley P, Cheng Earl Y, Pope John C, Brock John W, Adams Mark C, Austin Paul, Furness Peter D, Koyle Martin A
Children's Hospital of Oklahoma, Oklahoma City, Oklahoma, USA.
J Urol. 2002 Oct;168(4 Pt 2):1872-5; discussion 1875-6. doi: 10.1097/01.ju.0000027285.05828.e6.
Use of autologous rectus fascia for urethral slings in the pediatric population has produced reliable and predictable results. However, the potential morbidity and complications associated with harvesting the autologous rectus fascia have driven efforts to find a reliable off-the-shelf material for urethral slings. Small intestinal submucosa is a collagen based material that has been shown to promote tissue specific regeneration in a variety of organs. We report the clinical experience at 4 institutions with small intestinal submucosa for urethral slings.
A total of 20 patients 3 to 18 years old (mean age 8.7) received urethral slings using the commercially available form of small intestinal submucosa (STRATASIS, Cook Urologic Spencer, Indiana) via a sling suspension procedure from a suprapubic approach.
The material was consistently uniform to work with and user-friendly. All 20 patients tolerated the procedure well with no intraoperative complications. Postoperative followup has ranged from 9 to 26 months (mean 13), and 14 (70%) patients are completely dry (85% in females and 43% in males). Of the 14 dry patients 13 are on intermittent catheterization and 1 female with epispadias voids spontaneously.
This report is the largest and longest followup series using small intestinal submucosa as an "off the shelf" urethral sling material in children. These continence rates are equal to autologous fascia without additional morbidity of graft harvest.
在儿科患者中使用自体腹直肌筋膜进行尿道悬吊带术已取得可靠且可预测的效果。然而，获取自体腹直肌筋膜相关的潜在发病率和并发症促使人们努力寻找一种可靠的现成尿道悬吊带材料。小肠黏膜下层是一种基于胶原蛋白的材料，已被证明能促进多种器官的组织特异性再生。我们报告了4家机构使用小肠黏膜下层进行尿道悬吊带术的临床经验。
共有20例年龄在3至18岁（平均年龄8.7岁）的患者，通过耻骨上入路的悬吊带悬吊手术，使用市售形式的小肠黏膜下层（STRATASIS，库克泌尿外科公司，印第安纳州斯宾塞）进行尿道悬吊带术。
该材料使用起来始终均匀一致且方便用户操作。所有20例患者对手术耐受良好，无术中并发症。术后随访时间为9至26个月（平均13个月），14例（70%）患者完全无尿失禁（女性为85%，男性为43%）。在这14例无尿失禁的患者中，13例需要间歇性导尿，1例患有尿道上裂的女性可自主排尿。
本报告是使用小肠黏膜下层作为儿童“现成”尿道悬吊带材料的最大规模且随访时间最长的系列研究。这些控尿率与自体筋膜相当，且无额外的移植物获取相关发病率。
