Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75207, USA.
J Urol. 2010 Oct;184(4 Suppl):1775-80. doi: 10.1016/j.juro.2010.04.017. Epub 2010 Aug 21.
We compared continence results of the bladder neck sling vs the Leadbetter-Mitchell bladder neck procedure plus fascial sling in children with neurogenic urinary incontinence.
We compared consecutive patients who received a 360-degree tight bladder neck sling to subsequent, similar patients who underwent a Leadbetter-Mitchell bladder neck procedure plus fascial sling involving a 50% reduction in bladder neck and proximal urethral diameter before a 360-degree tight sling. All patients underwent simultaneous appendicovesicostomy and none had undergone prior or simultaneous augmentation. All patients followed similar preoperative and postoperative protocols for urodynamic evaluation and anticholinergic therapy with data maintained prospectively.
After surgery 46% of 35 sling cases did not require pads vs 82% of 17 Leadbetter-Mitchell cases with a sling (p = 0.02). Mean followup was 28 months in sling and 13 months in Leadbetter-Mitchell cases. Initial urodynamics done approximately 6 months postoperatively were similar in the 2 cohorts and no patient had hydronephrosis. Transient low grade reflux occurred in 2 Leadbetter-Mitchell cases, of which 1 with increased intravesical pressures early after surgery that caused trabeculation received increased medical management. Augmentation was not done in any patient except 1 previously reported on after a sling.
Patients undergoing Leadbetter-Mitchell procedure plus fascial sling were significantly less likely to require pads postoperatively than those with a sling alone. Adverse bladder changes have not required augmentation to date.
我们比较了吊带术与 Leadbetter-Mitchell 膀胱颈成形术联合筋膜吊带术治疗神经源性尿失禁的控尿效果。
我们比较了连续接受 360 度紧吊带术的患者与随后接受 Leadbetter-Mitchell 膀胱颈成形术联合筋膜吊带术的患者，后者膀胱颈和近端尿道直径减少 50%，然后进行 360 度紧吊带术。所有患者均同时行阑尾膀胱造口术，均未行先前或同期的膀胱扩大术。所有患者均遵循相似的术前和术后尿动力学评估及抗胆碱能治疗方案，数据前瞻性保存。
术后 46%的 35 例吊带术患者无需使用尿垫，而 17 例接受 Leadbetter-Mitchell 膀胱颈成形术联合筋膜吊带术的患者中 82%需要使用尿垫（p = 0.02）。吊带组的平均随访时间为 28 个月，Leadbetter-Mitchell 组为 13 个月。两组患者术后约 6 个月的初始尿动力学检查结果相似，且均无肾积水。2 例 Leadbetter-Mitchell 组患者出现短暂低级别反流，其中 1 例术后早期因膀胱内压力升高而出现小梁化，接受了更多的药物治疗。除 1 例报告接受吊带术治疗后发生的患者外，其他患者均未行膀胱扩大术。
与单独使用吊带术相比，接受 Leadbetter-Mitchell 膀胱颈成形术联合筋膜吊带术的患者术后使用尿垫的可能性明显降低。迄今为止，膀胱的不良反应尚未需要行膀胱扩大术。
