Parker R T, Addison W A, Wilson C J
Am J Obstet Gynecol. 1979 Dec 1;135(7):843-52. doi: 10.1016/0002-9378(79)90811-1.
Although the physiologic mechanisms of normal micturition in the female subject are not fully understood, it is generally believed that urinary continence is maintained by a competent urethrovesical neck. Unfortunately, the patient who has had multiple operations for recurrent stress urinary incontinence often has a urethra that is shortened and fixed in scar tissue. In such patients, anterior colporrhaphy with operative release of the periurethral fibrosis and plication of the endopelvic fascia to create a functionally more normal urethrovesical junction will increase the chances for good results. A fascia lata support of the proximal 1 to 2 cm of the urethra ensures continued elevation of the urethra and with stress the sling provides a pulling-up effect. Fifty patients with a suburethral sling procedure are presented in detail. Forty-seven of these patients had a total of 121 prior operative procedures for stress urinary incontinence. Urologic studies are outlined. Forty-two patients (84%) were continent postoperatively, five were improved, and three had failures. Operative technique and complications are discussed.
尽管女性正常排尿的生理机制尚未完全明了，但一般认为膀胱尿道连接部功能正常可维持尿失禁。不幸的是，因复发性压力性尿失禁接受多次手术的患者，其尿道往往缩短并固定于瘢痕组织中。对于此类患者，经阴道前路修补术并术中松解尿道周围纤维化，同时折叠盆腔内筋膜以形成功能上更正常的膀胱尿道连接部，将增加获得良好效果的机会。采用阔筋膜对尿道近端1至2厘米进行支撑，可确保尿道持续抬高，在施加压力时吊带可产生上提作用。本文详细介绍了50例接受尿道下吊带手术的患者。其中47例患者此前因压力性尿失禁共接受了121次手术。概述了泌尿外科检查情况。42例患者（84%）术后尿失禁得到控制，5例有所改善，3例手术失败。文中讨论了手术技术及并发症。
