Wadie Bassem S
Department of Urology, Urology and Nephrology Center, Mansoura, Egypt.
Scand J Urol Nephrol. 2007;41(5):398-402. doi: 10.1080/00365590701304023. Epub 2007 Apr 16.
The treatment of post-prostatectomy incontinence (PPI) can be challenging. Although many injectable materials have been used to treat this problem, the results are at best unsatisfactory. Fixation of an artificial urinary sphincter has been the gold standard of care for patients with PPI for many years. In the last decade there has been a revival of male sling techniques, involving either a fixed or dynamic compressive effect. Herein, a technique for the correction of PPI is described which involves minimal incursion of exogenous material and has excellent cost-effectiveness.
A total of 23 patients underwent a bulbourethral sling procedure using mesh suspended from the anterior abdominal wall for the management of PPI. The technique is performed under spinal anesthesia and utilizes knitted polypropylene mesh, which is fastened by three pairs of sutures. A modified Stamey needle is used for transferring nylon sutures to the suprapubic wound. The sutures are tied in front of the rectus sheath, utilizing intraoperative urodynamic guidance. A 12 F suprapubic tube is utilized as a pressure channel for monitoring vesical pressure and sling tension.
Twenty patients were completely dry at the last follow-up, one was greatly improved and in two the treatment was considered a failure. The median follow-up period was 9 months (range 6-24 months). No urethral erosion has been reported thus far. Morbidity in the form of perineal pain and limited ambulation in the first few days after surgery were reported. Five patients had scrotal and penile numbness which continued for an average of 3 months.
The mesh sling technique described herein is efficient and cost-effective. It yielded promising results in this study, which involved a short-term follow-up period and a limited number of patients. More cases are being enrolled and a study involving a longer follow-up period is underway.
前列腺切除术后尿失禁（PPI）的治疗颇具挑战性。尽管已使用多种可注射材料来治疗这一问题，但结果充其量不尽人意。多年来，人工尿道括约肌固定术一直是PPI患者的护理金标准。在过去十年中，男性吊带技术再度兴起，包括固定或动态压迫效应。本文描述了一种纠正PPI的技术，该技术涉及极少的外源材料侵入且具有出色的成本效益。
共有23例患者接受了球部尿道吊带手术，使用从前腹壁悬吊的网片来治疗PPI。该技术在脊髓麻醉下进行，使用针织聚丙烯网片，通过三对缝线固定。使用改良的斯塔米针将尼龙缝线转移至耻骨上伤口。利用术中尿动力学引导，在腹直肌鞘前方打结缝线。使用一根12F的耻骨上导管作为压力通道，用于监测膀胱压力和吊带张力。
在最后一次随访时，20例患者完全干爽，1例明显改善，2例治疗被认为失败。中位随访期为9个月（范围6 - 24个月）。迄今为止，未报告尿道侵蚀情况。报告了术后头几天出现会阴部疼痛和行走受限形式的并发症。5例患者出现阴囊和阴茎麻木，平均持续3个月。
本文所述的网片吊带技术高效且具有成本效益。在本涉及短期随访期和有限患者数量的研究中取得了有前景的结果。正在纳入更多病例，并且正在进行一项涉及更长随访期的研究。
