Castellan M, Gosalbez R, Labbie A, Ibrahim E, Disandro M
Division of Pediatric Urology, Miami Children's Hospital and Jackson Memorial Hospital, and Department of Urology, University of Miami, Miami, Florida, USA.
J Urol. 2005 Jun;173(6):2128-31; discussion 2131. doi: 10.1097/01.ju.0000157688.41223.d2.
We retrospectively reviewed the outcome and long-term followup (mean 4.16 years) of bladder neck slings for the treatment of neurogenic urinary incontinence in 58 patients (15 males) who also underwent bladder augmentation.
A total of 58 patients with neurogenic bladder (43 females and 15 males, median age 11.4 years) underwent a rectus fascial sling procedure as part of the reconstructive efforts for continence between July 1991 and July 2003. Criteria for enhancement of bladder outlet resistance included a detrusor leak point pressure of less than 45 cm H2O, an open bladder neck during bladder filling at low detrusor pressures and clinical evidence of stress incontinence.
Followup ranged from 1 year to 10 years, 3 months (mean 4.16 years). A total of 51 patients (88%) obtained good continence results. Five females and 2 males remained incontinent following the sling procedure. Four females underwent a secondary open bladder neck procedure at a mean of 18 months after the initial procedure (artificial urinary sphincter in 2, bladder neck closure in 2). Two male patients (5 and 17 years old) had daily underwear staining or dampness with exercise or transfer.
We consider bladder neck slings the procedure of choice for the enhancement of bladder outlet resistance in the majority of patients with neurogenic bladder who need augmentation cystoplasty and whom we do not expect will be capable of voiding spontaneously. In males and females satisfactory long-term continence can be expected with the use of the rectus fascial sling.
我们回顾性分析了58例（15例男性）接受膀胱扩大术的神经源性尿失禁患者行膀胱颈悬吊术的治疗结果及长期随访情况（平均4.16年）。
1991年7月至2003年7月期间，共有58例神经源性膀胱患者（43例女性，15例男性，中位年龄11.4岁）接受了腹直肌筋膜悬吊术，作为控尿重建手术的一部分。增强膀胱出口阻力的标准包括逼尿肌漏点压小于45 cm H2O、膀胱低压充盈时膀胱颈开放以及压力性尿失禁的临床证据。
随访时间为1年至10年3个月（平均4.16年）。共有51例患者（88%）获得了良好的控尿效果。5例女性和2例男性在悬吊术后仍有尿失禁。4例女性在初次手术后平均18个月接受了二次开放性膀胱颈手术（2例植入人工尿道括约肌，2例进行膀胱颈闭合术）。2例男性患者（5岁和17岁）在运动或转移时每天内裤有染色或潮湿现象。
对于大多数需要膀胱扩大成形术且预计无法自主排尿的神经源性膀胱患者，我们认为膀胱颈悬吊术是增强膀胱出口阻力的首选手术方法。使用腹直肌筋膜悬吊术，男性和女性均可获得满意的长期控尿效果。
