Professorial Department of Surgery, University of NSW, St Vincent's Hospital, Sydney, Australia.
FA für Gynäkologie, Geburtshilfe und Chirurgie, Leiter der Abteilung für Gynäkologie und Geburtshilfe, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Austria.
Neurourol Urodyn. 2019 Feb;38(2):814-817. doi: 10.1002/nau.23841. Epub 2018 Dec 21.
Part 1, The original 1990 science behind the MUS, the hypothesized closure mechanisms, and the prototype MUS itself were presented. The next phase of MUS development began in 1990 in collaboration with the late Ulf Ulmsten. It had two arms Further development of the prototype MUS. Further anatomical, imaging, urodynamic studies to validate the role of PUL in the closure mechanisms. A second series of prototype MUS operations performed under LA/sedation resulted in a permanently implanted polypropylene sling and the MUS as is known today. The tape was elevated until no urine leaked on coughing. This demonstrated that the artificial PUL neoligament needed to be at a specific length to work. Anatomical, EMG and video ultrasound, and X-ray studies confirmed three directional muscles contracted pubourethral (PUL) and uterosacral (USL) ligaments. The contribution of the horseshoe shaped rhabdosphincter (RS) to continence was directly tested with pressure measurements under live surgery conditions. It was concluded that the RS was responsible for pressure generation but not continence. Continence was a consequence of intraurethral resistance to flow created by the distal and proximal urethral closure mechanisms, both governed ultimately by the Law of Poiseuille. CONCLUSIONS: The key element in curing USI is creation of a competent PUL using the collagenous neoligament surgical principle described in Part 1. This creates a firm insertion point for the three directional muscle forces, restoring their contractile strength and closure.
部分 1 介绍了 MUS 的原始 1990 年科学依据、假设的闭合机制以及原型 MUS 本身。MUS 的下一阶段发展始于 1990 年，与已故的 Ulf Ulmsten 合作。它有两个分支进一步开发原型 MUS。进一步的解剖学、成像、尿动力学研究，以验证 PUL 在闭合机制中的作用。在局部麻醉/镇静下进行的第二系列原型 MUS 手术导致永久性植入聚丙烯吊带和今天众所周知的 MUS。将带子抬高，直到咳嗽时不再漏尿。这表明人造 PUL 新韧带需要达到特定的长度才能发挥作用。解剖学、肌电图和视频超声以及 X 射线研究证实，三个方向的肌肉收缩耻骨尿道（PUL）和子宫骶骨（USL）韧带。直接在活体手术条件下进行压力测量，测试马蹄形横纹肌（RS）对尿失禁的贡献。得出的结论是，RS 负责产生压力，但不能保持尿失禁。尿失禁是由远端和近端尿道闭合机制产生的尿道内阻力导致的，这两个机制最终都受泊肃叶定律的控制。结论：治愈尿失禁的关键要素是使用第 1 部分中描述的胶原性新韧带手术原理创建有能力的 PUL。这为三个方向的肌肉力量创造了一个坚固的插入点，恢复了它们的收缩强度和闭合。
