Stothers L, Chopra A, Raz S
Department of Surgery, UCLA School of Medicine, USA.
Urol Clin North Am. 1995 Aug;22(3):641-55.
The surgical procedure of choice to correct stress urinary incontinence using a vaginal approach depends not only on the anatomic origin of the incontinence (hypermobility or intrinsic sphincter dysfunction) but also on the degree of coexistent anterior vaginal wall prolapse. The grade of coexistent cystocele and the finding of a central or lateral defect are important observations that help the surgeon plan the optimum surgical approach. Grade 4 cystocele with central and lateral defects represents the most severe form of anterior vaginal wall prolapse. In this case, the surgical goals are to correct both central and lateral defects, as well as hypermobility related to the mid-urethra and bladder neck.
采用经阴道入路矫正压力性尿失禁的首选手术方法不仅取决于尿失禁的解剖学根源（尿道过度活动或固有括约肌功能障碍），还取决于并存的阴道前壁脱垂程度。并存膀胱膨出的分级以及中央或侧方缺损的发现是有助于外科医生规划最佳手术入路的重要观察指标。伴有中央和侧方缺损的4级膀胱膨出代表阴道前壁脱垂的最严重形式。在这种情况下，手术目标是矫正中央和侧方缺损，以及与尿道中段和膀胱颈相关的尿道过度活动。
