Elder J S
Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106.
J Urol. 1990 Aug;144(2 Pt 2):434-7; discussion 443-4. doi: 10.1016/s0022-5347(17)39483-1.
The surgical management of sphincteric incompetence in patients with myelodysplasia is a formidable problem. In 10 female patients and 4 male patients with myelodysplasia a free graft of rectus fascia was used to suspend the urethra, termed the periurethral and puboprostatic sling procedures, respectively. All but 1 patient also underwent augmentation cystoplasty, usually with sigmoid colon. Patient age ranged from 7 to 25 years (mean 12.6 years) and followup ranged from 2 to 27 months (mean 12 months). Of the patients 12 are completely dry on clean intermittent catheterization, 1 has undergone 2 subsequent urethral suspension procedures but remains incontinent and 1 experiences nocturnal enuresis but is dry during the day. The periurethral sling appears to be as effective as the artificial urinary sphincter, the Young-Dees-Leadbetter bladder neck reconstruction and the Kropp procedure in the management of sphincteric incompetence in female patients. In male patients experience with the puboprostatic sling is limited but thus far it is encouraging.
脊髓发育不良患者括约肌功能不全的外科治疗是一个棘手的问题。在10例女性和4例男性脊髓发育不良患者中，分别采用腹直肌筋膜游离移植悬吊尿道，即分别称为尿道周围悬吊术和耻骨后前列腺悬吊术。除1例患者外，所有患者均接受了膀胱扩大术，通常采用乙状结肠。患者年龄7至25岁（平均12.6岁），随访时间2至27个月（平均12个月）。其中12例患者通过清洁间歇性导尿完全无尿失禁，1例患者随后接受了2次尿道悬吊术，但仍有尿失禁，1例患者有夜间遗尿，但白天无尿失禁。尿道周围悬吊术在治疗女性患者括约肌功能不全方面似乎与人工尿道括约肌、Young-Dees-Leadbetter膀胱颈重建术及Kropp手术效果相当。男性患者耻骨后前列腺悬吊术的经验有限，但迄今为止结果令人鼓舞。
