Kadar N, Nelson J H
Obstet Gynecol. 1984 Sep;64(3):400-5.
The results of therapy of eight previously untreated women without urinary fistulas who had been severely incontinent for three to eight years after radical hysterectomy are presented and the principles of management discussed. Radiologic and urodynamic studies are required to assess the bladder pressure response to filling, proximal urethral pressures, bladder neck closure at rest, and mobility of the bladder neck, to determine the mechanism responsible for the urine loss and to select appropriate therapy. Augmentation of proximal urethral pressures by medical or surgical means is required if the bladder neck is open at rest. All such patients improved dramatically on ephedrine, but tachyphylaxis developed in cases of total sphincter failure. Retropubic urethropexy did not relieve the incontinence in these cases, whereas a sling operation restored complete continence. If an incremental bladder pressure response to filling is present, operations to increase bladder outlet resistance are contraindicated. Treatment with anticholinergic medications was unsuccessful in these cases.
本文介绍了8例根治性子宫切除术后出现严重尿失禁3至8年且此前未接受过治疗、无尿瘘的女性患者的治疗结果，并讨论了治疗原则。需要进行放射学和尿动力学研究，以评估膀胱对充盈的压力反应、近端尿道压力、静息时膀胱颈闭合情况以及膀胱颈的活动度，从而确定尿失禁的机制并选择合适的治疗方法。如果静息时膀胱颈开放，则需要通过药物或手术方法增加近端尿道压力。所有这些患者使用麻黄碱后均有显著改善，但在完全括约肌功能衰竭的病例中会出现快速耐受现象。耻骨后尿道固定术在这些病例中并不能缓解尿失禁，而吊带手术可恢复完全控尿。如果存在膀胱对充盈的递增压力反应，则禁忌进行增加膀胱出口阻力的手术。在这些病例中，使用抗胆碱能药物治疗无效。
