Baldissera-Aradas J V, Rodríguez-Villamil L, González-Rodríguez I, Gil-Ugarteburu R, Fernández-Pello-Montes S, Mosquera-Madera J
Departamento de Urología, Hospital de Cabueñes, Gijón, España.
Departamento de Urología, Hospital de Cabueñes, Gijón, España.
Actas Urol Esp. 2016 Jul-Aug;40(6):406-11. doi: 10.1016/j.acuro.2015.12.012. Epub 2016 Feb 19.
The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence.
Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine.
The surgical time was 92min, the estimated blood loss was <100cc(3) and the hospital stay was 48h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved.
Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions.
抗尿失禁手术的失败率在5%至80%之间。对于使用人工尿道括约肌（AUS）治疗女性复发性尿失禁，目前尚无实际共识。几位作者表明，如果检查出存在内在括约肌缺陷，AUS可能会有用。据我们所知，我们介绍了西班牙首例腹腔镜植入AUS治疗女性复发性尿失禁的病例。
在全身麻醉下，患者取仰卧位并稍作头低脚高位，确认阴道通路。通过经腹盆腔腹腔镜入路，打开Retzius间隙，然后直至盆内筋膜打开阴道旁间隙。为便于膀胱颈的解剖，我们将一根拭子插入阴道，同时进行牵引和对抗牵引操作。作为AUS的接入端口，我们扩大了下套管的切口。我们调整了尿道周围袖带，然后分别将储液器和泵放置在膀胱旁间隙和外阴大阴唇内。最后，我们连接了AUS的三个部件，并关闭腹膜以将AUS与肠道隔离。
手术时间为92分钟，估计失血量<100cc(3)，住院时间为48小时。无术中或术后并发症。AUS在6周时激活。在24个月时，患者能充分操控AUS并实现了完全控尿。
腹腔镜植入AUS是一种可行的技术。经阴道牵引和对抗牵引操作可防止术中损伤。
