Stricker P D
St. Vincent's Private Medical Centre, Sydney, NSW, Australia.
Int J Urol. 1995 Apr;2 Suppl 1:2-6; discussion 16-8.
Stress incontinence affects primarily women, and a common cause is intrinsic sphincter deficiency (ISD). Traditionally, patients with ISD are treated surgically with implantation of an artificial sphincter or with a pubovaginal sling procedure. Although these procedures are effective, an alternate nonsurgical treatment option is Contigen Bard Collagen Implant. Ensuring optimal results with Contigen Implant requires proper diagnosis and patient selection. Contigen Implant is indicated for the treatment of urinary incontinence from ISD. Candidates are usually females with at least one previous failed suspension and with an open bladder neck at rest. Patients with a hypermobile urethra, high leak point pressures, or significant detrusor problems are poor candidates for Contigen. Those who are considered for Contigen should undergo a diagnostic evaluation to confirm the presence of incontinence, identify contributing factors, and identify the need for further diagnostic evaluation. The basic evaluation can be performed by any physician. It consists of a thorough history, physical examination, and urinalysis. It may also include a patient diary of voiding activity and a pad test to quantify the degree of incontinence. Those patients in whom incontinence is confirmed with a basic evaluation should undergo urodynamic evaluation by an experienced urologist. The object is to identify the specific cause of incontinence, detect functional, neurological, or anatomic lesions, and help select the most appropriate therapy. The urodynamic evaluation consists of cystometry, uroflowmetry, cystogram with voiding cystourethrogram, determination of leak point pressure and post-void residual, and videourodynamic studies if indicated. Optimal outcomes with Contigen Implant will be realized through proper patient selection, and this requires a thorough patient evaluation.
压力性尿失禁主要影响女性，常见原因是内在括约肌缺陷（ISD）。传统上，ISD患者通过植入人工括约肌或耻骨后阴道吊带术进行手术治疗。尽管这些手术有效，但一种替代的非手术治疗选择是Contigen Bard胶原蛋白植入物。要确保Contigen植入物取得最佳效果，需要进行正确的诊断和患者选择。Contigen植入物适用于治疗ISD引起的尿失禁。候选人通常是至少有一次先前悬吊手术失败且静息时膀胱颈开放的女性。尿道活动过度、漏尿点压力高或存在明显逼尿肌问题的患者不是Contigen的合适候选人。考虑使用Contigen的患者应接受诊断评估，以确认尿失禁的存在、确定促成因素，并确定是否需要进一步的诊断评估。基本评估可由任何医生进行。它包括详细的病史、体格检查和尿液分析。还可能包括排尿活动的患者日记和用于量化尿失禁程度的尿垫试验。那些通过基本评估确诊为尿失禁的患者应由经验丰富的泌尿科医生进行尿动力学评估。目的是确定尿失禁的具体原因，检测功能、神经或解剖病变，并帮助选择最合适的治疗方法。尿动力学评估包括膀胱测压、尿流率测定、排尿期膀胱尿道造影的膀胱造影、漏尿点压力和排尿后残余尿量的测定，以及必要时的影像尿动力学研究。通过正确的患者选择才能实现Contigen植入物的最佳效果，而这需要对患者进行全面评估。
