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[男性术后压力性尿失禁的外科治疗新技术]

[New techniques for surgical treatment of postoperative male stress incontinence].

作者信息

Bross S, Kwon S T, Peter S, Honeck P

机构信息

Urologische Klinik, Klinikum Darmstadt, 64283, Darmstadt, Deutschland.

出版信息

Urologe A. 2007 Mar;46(3):257-8, 260-3. doi: 10.1007/s00120-007-1300-2.

Abstract

The impact of minimally invasive techniques for the treatment of postoperative male incontinence has significantly improved in recent years. These techniques are based on the continuous increase in urethral resistance. This resistance can be readjusted with balloons placed paraurethrally or with readjustable suburethral slings. The success rates depend on the preoperative degree of incontinence. With bulking agents that are transurethrally injected into the submucosa of the sphincter, continence rates between 12 and 90% can be seen. Severe complications are rare. The impact of the studies is often limited due to a short follow-up. After implantation of adjustable balloons that are placed paraurethrally close to the bladder neck, continence rates up to 70% can be seen. The overall improvement of incontinence is observed in up to 90% of the treated patients. Complications such as balloon migration or mechanical disorders can cause operative revision. Suburethral sling systems are available as bone-anchored slings or as readjustable slings. Continence can be seen in up to 90% of the patients postoperatively. Severe complications such as sling erosion or sling infection are rare. In cases of mild and moderate incontinence, these minimally invasive techniques are good alternatives to the fascial sling or alloplastic sphincter implantation. To improve the evaluation and to compare these techniques with the conventional methods, further investigations with a longer follow-up are necessary.

摘要

近年来,微创技术对术后男性尿失禁的治疗效果有了显著改善。这些技术基于尿道阻力的持续增加。这种阻力可通过尿道旁放置的球囊或可调节的尿道下吊带进行重新调整。成功率取决于术前尿失禁的程度。通过经尿道将填充剂注射到括约肌黏膜下层,控尿率可达12%至90%。严重并发症很少见。由于随访时间短,这些研究的影响往往有限。在尿道旁靠近膀胱颈处植入可调节球囊后,控尿率可达70%。高达90%的接受治疗的患者尿失禁情况得到整体改善。球囊移位或机械故障等并发症可能需要进行手术修复。尿道下吊带系统有骨锚定吊带或可调节吊带。术后高达90%的患者可实现控尿。吊带侵蚀或吊带感染等严重并发症很少见。对于轻度和中度尿失禁病例,这些微创技术是筋膜吊带或异体括约肌植入术的良好替代方案。为了改进评估并将这些技术与传统方法进行比较,有必要进行更长时间随访的进一步研究。

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