Dik Pieter, Klijn Aart J, van Gool Jan D, de Jong Tom P V M
Pediatric Renal Center, University Children's Hospital UMC Utrecht, The Netherlands.
J Urol. 2003 Aug;170(2 Pt 1):580-1; discussion 581-2. doi: 10.1097/01.ju.0000071477.49755.61.
Many surgical options exist to enhance bladder neck closing pressure in women. Most procedures are relatively large with a success rate of between 70% and 90%. Sling procedures with the sling placed between the anterior vaginal wall and bladder neck cause a risk of traumatic lesions of the bladder neck at operation and of postoperative erosion of the sling into the urethra. We evaluated the results of surgical treatment for neurogenic pelvic floor paralysis in girls with spina bifida by transvaginal rectus abdominis sling suspension.
Between 1991 and 2001 we treated 24 girls with a pubovaginal sling placed through the vagina. Patient age at operation was 1 to 17 years (mean 9). After identification of the bladder neck and anterior vaginal wall 2 small holes were made into the vagina left and right of the bladder neck. The sling was taken through these holes and fixed to the contralateral pubic bone. The sling procedure has been combined with ileocystoplasty, auto-augmentation, a continent catheterizable stoma and ureteral reimplantation when needed.
Of the 24 patients 19 were dry after the initial procedure and 3 others became dry after a total of 4 additional injections of a bulking agent into the bladder neck via suprapubic needle introduction under transurethral endoscopic guidance. A patient underwent bladder neck closure after a vesicovaginal fistula developed from the ileal bladder and another primarily elected bladder neck closure for persistent urinary incontinence. No infectious complications occurred that were related to the procedure. Clean intermittent catheterization was possible in all patients.
Transvaginal sling suspension is safe, relatively easy to perform and cost-effective compared with most alternative procedures. It appears to be as successful as other more complicated procedures to achieve urinary continence in girls with spina bifida.
有多种外科手术方法可用于提高女性膀胱颈闭合压。大多数手术规模相对较大，成功率在70%至90%之间。将吊带置于阴道前壁和膀胱颈之间的吊带手术，在手术时有造成膀胱颈创伤性损伤以及术后吊带侵蚀入尿道的风险。我们通过经阴道腹直肌吊带悬吊术评估了脊柱裂女孩神经源性盆底麻痹的外科治疗结果。
1991年至2001年间，我们经阴道为24名女孩置入耻骨阴道吊带。手术时患者年龄为1至17岁（平均9岁）。在确定膀胱颈和阴道前壁后，于膀胱颈左右两侧的阴道上各做一个小孔。将吊带穿过这些小孔并固定于对侧耻骨。必要时，吊带手术已与回肠膀胱扩大术、自体膀胱扩大术、可控性造口术及输尿管再植术联合应用。
24例患者中，19例在初次手术后实现了控尿，另外3例在经尿道内镜引导下经耻骨上针向膀胱颈总共额外注射4次填充剂后实现了控尿。1例患者因回肠膀胱出现膀胱阴道瘘而接受了膀胱颈闭合术，另1例患者因持续性尿失禁而最初选择了膀胱颈闭合术。未发生与手术相关的感染性并发症。所有患者均可行清洁间歇性导尿。
与大多数其他手术相比，经阴道吊带悬吊术安全、操作相对简便且具有成本效益。在实现脊柱裂女孩尿失禁控制方面，它似乎与其他更复杂的手术一样成功。
