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, Australia.
Neurourol Urodyn. 2019 Feb;38(2):809-813. doi: 10.1002/nau.23888. Epub 2018 Dec 21.
To summarize the mechanics of urethral closure, incontinence, and midurethral sling repair, a work in 3 parts Part 1. Original scientific studies (1990). Part 2. Experimental validation of reliance of the closure mechanisms on a competent PUL (1993-2003). Part 3. Surgery (1990-2016).
Part1. Two unrelated observations in the mid 1980s led to the discovery of the MUS: a hemostat applied on one side of the midurethral area of the vagina, controlled urine loss on coughing without bladder neck elevation; an implanted Teflon tape cause a collagenous reaction. It was hypothesized that urinary stress incontinence (USI) was caused by collagen loss in the pubourethral ligament (PUL) and a tape implanted in the exact position of PUL would reinforce it and cure USI. A tape removable at 6 weeks was configured as an inverted "U" in the vagina and lowered sequentially.
At a certain point, the patient was continent on coughing but was able to pass urine freely. This proved the mechanism for continence was not obstructive. Post-op xrays showed no elevation of bladder neck. This invalidated Enhorning's Theory. Ultrasound showed closure of distal urethra from behind and descent of vaginal fornix on straining. This indicated there were two closure mechanisms, distal urethral, and bladder neck. Three months following sling removal, there was a 50% failure rate.
The 1990 results indicated a permanent sling was required for the MUS. Further proofs were required for the proposed musculoelastic mechanisms.
总结尿道闭合、尿失禁和中段尿道吊带修复的机制，分为三部分进行阐述。第 1 部分。原始科学研究（1990 年）。第 2 部分。闭合机制对有功能的耻骨尿道韧带（PUL）的依赖的实验验证（1993-2003 年）。第 3 部分。手术（1990-2016 年）。
第 1 部分。20 世纪 80 年代中期的两个不相关的观察结果导致了 MUS 的发现：一种止血夹应用于阴道中段尿道区域的一侧，可控制咳嗽时的尿液漏出而无需抬高膀胱颈；植入的特氟隆带引起胶原反应。当时假设尿失禁是由耻骨尿道韧带（PUL）中的胶原丢失引起的，而植入 PUL 确切位置的带子会加强它并治愈尿失禁。一种可在 6 周内移除的带子在阴道中被配置为倒置的“U”形，并依次降低。
在某个时刻，患者在咳嗽时能够保持尿失禁，但能够自由排尿。这证明了保持尿失禁的机制不是阻塞性的。术后 X 光片显示膀胱颈无抬高。这否定了 Enhorning 的理论。超声显示远端尿道从后面关闭，阴道穹窿在用力时下降。这表明存在两种闭合机制，即远端尿道和膀胱颈。吊带移除后 3 个月，失败率为 50%。
1990 年的结果表明，MUS 需要永久性吊带。需要进一步证明所提出的肌肉弹性机制。
