Nichols D H
Clin Obstet Gynaecol. 1985 Jun;12(2):449-64.
When pelvic reconstructive surgery is being considered, it is important that the presence of cystocele be carefully and accurately assessed preoperatively and intraoperatively so that appropriate correction can be achieved. Continence is under the influence of urethral tone and the response of the proximal urethra to changes in intra-abdominal pressure. Cranial elevation of a rotated vesicourethral junction to a normal retropubic position should be provided. Any surgical technique that alters the normal axis of the vagina should be accompanied by simultaneous obliteration of the cul-de-sac of Douglas to lessen the chance of postoperative enterocele and subsequent eversion of the vault of the vagina. When massive vaginal eversion causes displacement of the vesicourethral junction, a restoration of vaginal depth and axis by post-hysterectomy transvaginal sacrospinous colpopexy with appropriate colporrhaphy will relocate a defective urethrovesical site to a higher and retropubic level within the pelvis, where the proximal urethra may once again be responsive to changes in intra-abdominal pressure.
在考虑进行盆腔重建手术时，术前和术中仔细准确地评估膀胱膨出的存在非常重要，以便能够进行适当的矫正。控尿受尿道张力以及近端尿道对腹内压变化的反应影响。应将旋转的膀胱尿道连接部向头侧抬高至耻骨后正常位置。任何改变阴道正常轴线的手术技术都应同时封闭Douglas陷凹，以减少术后发生肠膨出及随后阴道穹隆外翻的几率。当巨大的阴道外翻导致膀胱尿道连接部移位时，通过子宫切除术后经阴道骶棘韧带阴道固定术并进行适当的阴道修补术来恢复阴道深度和轴线，将使有缺陷的尿道膀胱部位重新定位到盆腔内更高的耻骨后水平，近端尿道在该位置可能会再次对腹内压变化产生反应。
