Ruiz-Hernández M, López-Fando L, Gómez de Vicente J M, Jiménez-Cidre M A, Sánchez-Gallego M D, Lorca-Álvaro J, Díaz-Pérez D, Burgos-Revilla F J
Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
Actas Urol Esp (Engl Ed). 2019 Jan-Feb;43(1):44-50. doi: 10.1016/j.acuro.2018.04.001. Epub 2018 Jul 29.
The artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck.
We present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection.
Surgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent.
We present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.
由于所使用技术的可重复性差，人工尿道括约肌（AUS）在女性压力性尿失禁（USI）治疗中未得到广泛应用。我们描述了一种腹腔镜植入的新方法，其中膀胱阴道间隙的解剖是关键步骤。这使得能够在直视下接近膀胱颈后表面。
我们展示了两例采用该方法的病例。在头低脚高位采用经腹途径。主要步骤包括：创建膀胱阴道间隙直至识别膀胱颈，创建两个膀胱外侧间隙，使其与膀胱阴道间隙相通，解剖膀胱颈前表面，尽量保留耻骨膀胱韧带。袖带和储液器通过脐下12mm套管插入。连接通过耻骨上左侧切口引出，并通过皮下隧道延伸至大阴唇，在此处放置激活泵。手术以关闭腹膜完成。使用阴道瓣膜有助于解剖至关重要。
手术时间分别为140分钟和135分钟，术中无并发症。拔除导尿管后，一名患者残余尿量增加，经保守治疗。住院时间：72小时。在3个月和9个月时，患者完全控尿。
我们展示了通过膀胱阴道途径对膀胱颈后表面进行腹腔镜植入AUS的初步结果，这可能减少常规技术后观察到的潜在并发症。
