Ishizaka K, Koga H, Kamata S, Nagamatsu H, Yamada T
Department of Urology, Tokyo Medical and Dental University School of Medicine.
Hinyokika Kiyo. 1995 Jul;41(7):553-6.
A 77-year-old man had been suffering from stress urinary incontinence for 2 years since he had received transurethral resection of prostate (TUR-P) for benign prostatic hypertrophy. A 60-min pad test yielded 3 g of urine. Prostatic urethra was widely open and the external sphincteric injury was suggested because of the short membraneous urethra on the urethrogram. Urethral pressure profile indicated his maximal urethral closing pressure (MUCP) of 24 cmH2O and functional urethral length of 1.6 cm and cystometry demonstrated an underactive bladder, indicating that his incontinence was caused by sphincteric injury. Autologous fat injection therapy was performed in the lithotomy position under spinal anesthesia. Fifteen ml of subcutaneous fat was obtained from his lower abdomen by liposuction through a 15G needle, and 10 ml was injected submucosally from the perineum at 6 o'clock area of the prostatic apex under the guidance of transrectal echography using a 15G needle. The patient became completely dry after the procedure. MUCP and FUL increased to 35 cmH2O and 1.9 cm, respectively, although longer follow up is necessary. The advantage of autologous fat injection to the prostate for post-TUR-P SUI patients is briefly discussed.
一名77岁男性因良性前列腺增生接受经尿道前列腺电切术（TUR-P）后，压力性尿失禁已持续2年。60分钟的尿垫试验显示漏尿量为3克。前列腺尿道广泛开放，尿道造影显示膜部尿道短，提示外括约肌损伤。尿道压力图显示其最大尿道闭合压（MUCP）为24 cmH₂O，功能性尿道长度为1.6 cm，膀胱测压显示膀胱活动低下，表明其尿失禁是由括约肌损伤引起的。在脊髓麻醉下于截石位进行自体脂肪注射治疗。通过15G针头经吸脂术从其下腹部获取15毫升皮下脂肪，然后在经直肠超声引导下，使用15G针头从会阴在前列腺尖部6点钟区域黏膜下注射10毫升。术后患者完全不再漏尿。尽管需要更长时间的随访，但MUCP和功能性尿道长度分别增加到了35 cmH₂O和1.9 cm。本文简要讨论了对TUR-P术后压力性尿失禁患者进行前列腺自体脂肪注射的优势。
