Carey M P, Dwyer P L
Department of Obstetrics and Gynaecology, University of Melbourne, Victoria.
Aust N Z J Obstet Gynaecol. 1991 Aug;31(3):279-84. doi: 10.1111/j.1479-828x.1991.tb02799.x.
The position of the urethrovesical junction and its movement with straining was assessed using lateral chain cystourethrography in 9 continent women and 27 women with genuine stress incontinence before and after continence surgery. The women with genuine stress incontinence had a significantly lower urethrovesical junction related to the symphysis pubis which descended more with straining than the continent women. Surgery was successful in 25 of the 27 women. Following both successful Burch colposuspension and Stamey operation the urethrovesical junction was significantly higher, closer to the symphysis and less mobile. The position of the urethrovesical junction was significantly higher following the Burch colposuspension than Stamey operation and was similar to the continent control group. Overelevation of the urethrovesical junction can be avoided at the time of Burch colposuspension by not tying the suspension sutures with excessive tension but leaving a free space of 2-4 cm between the vaginal wall below and the iliopectineal ligament above. The posterior urethrovesical angle was similar in continent and incontinent women but was significantly narrower following successful surgery.
采用侧位链膀胱尿道造影术，对9名无尿失禁的女性以及27名真性压力性尿失禁女性在尿失禁手术前后尿道膀胱连接部的位置及其在用力时的移动情况进行了评估。真性压力性尿失禁女性的尿道膀胱连接部相对于耻骨联合的位置明显更低，且在用力时下降幅度比无尿失禁的女性更大。27名女性中有25名手术成功。在成功进行Burch阴道旁修补术和Stamey手术之后，尿道膀胱连接部明显更高，更靠近耻骨联合，且移动性更小。Burch阴道旁修补术后尿道膀胱连接部的位置明显高于Stamey手术后，且与无尿失禁的对照组相似。在进行Burch阴道旁修补术时，通过不过度拉紧悬吊缝线，而是在下方阴道壁与上方髂耻韧带之间留出2 - 4厘米的自由空间，可以避免尿道膀胱连接部过度抬高。无尿失禁和尿失禁女性的后尿道膀胱角相似，但在手术成功后明显变窄。
