Bugg Charles E, Joseph David B
Division of Urology, University of Alabama at Birmingham and Childre's Hospital, Alabama 35233, USA.
J Urol. 2003 Oct;170(4 Pt 2):1501-3; discussion 1503-4. doi: 10.1097/01.ju.0000084145.34813.97.
The fascial bladder neck sling achieves continence in 50% to 90% of children with neurogenic outlet deficiency. Most slings apply only partial pressure around the bladder neck. We evaluated the effectiveness of a rectus fascia bladder neck cinch which applies circumferential pressure around the bladder neck and elevation as a means of increasing outlet resistance.
Fifteen children with spina bifida underwent a fascial bladder neck cinch procedure at the time of augmentation cystoplasty. A 1 to 1.5 cm width of variable length rectus fascia was harvested and a vertical slit was made in 1 end. The fascia was "cinched" tightly around the bladder neck and secured to the symphysis or rectus fascia.
The 14 girls and 1 boy ranged in age range from 4 to 17 years. All children had neurogenic intrinsic sphincter deficiency and a poorly compliant and/or small capacity bladder. Followup ranged from 10 to 36 months (followup in 12 greater than 1 year). Postoperatively, all children perform clean intermittent catheterization. At the last followup 8 girls and the boy (60%) were dry (no leak and no pads at 4 hours from the last catheterization and dry throughout the night).
Rectus fascia used as a bladder neck cinch is effective but no better than other bladder neck slings for decreasing urinary incontinence. The bladder neck cinch appears to be an acceptable addition to the technique of fascial slings. However, we have subsequently changed our technique because these results did not meet our expectations.
筋膜膀胱颈悬吊术使50%至90%的神经源性出口功能不全患儿实现控尿。大多数悬吊术仅对膀胱颈施加部分压力。我们评估了一种腹直肌筋膜膀胱颈束紧术的有效性，该术式通过围绕膀胱颈施加圆周压力并抬高来增加出口阻力。
15例脊柱裂患儿在膀胱扩大成形术时接受了筋膜膀胱颈束紧术。取1至1.5厘米宽、长度可变的腹直肌筋膜，在一端做一个垂直切口。将筋膜紧紧“束紧”在膀胱颈周围，并固定于耻骨联合或腹直肌筋膜上。
14名女孩和1名男孩，年龄在4至17岁之间。所有患儿均患有神经源性固有括约肌功能不全，膀胱顺应性差和/或容量小。随访时间为10至36个月（12例随访超过1年）。术后，所有患儿均进行清洁间歇性导尿。在最后一次随访时，8名女孩和该男孩（60%）实现了干爽（最后一次导尿后4小时无漏尿且无需使用尿垫，整夜干爽）。
用作膀胱颈束紧的腹直肌筋膜是有效的，但在减少尿失禁方面并不比其他膀胱颈悬吊术更好。膀胱颈束紧术似乎是筋膜悬吊术技术中可接受的补充。然而，由于这些结果未达到我们的期望，我们随后改变了技术。
