Salle J L, de Fraga J C, Amarante A, Silveira M L, Lambertz M, Schmidt M, Rosito N C
Division of Pediatric Surgery and Urology, Hospital de Clinicas de Porto Alegre, Hospital de Criança Conceicão, Porto Alegre, Brazil.
J Urol. 1994 Aug;152(2 Pt 2):803-6. doi: 10.1016/s0022-5347(17)32715-5.
Urethral irregularity (impeding catheterization) and failure to achieve continence are common complications in surgery for urinary incontinence. We describe a surgical technique using an anterior bladder wall flap that is sutured to the posterior wall in an onlay fashion creating a flap valve mechanism. Experimental work in dogs demonstrated a significant increase in the leak point pressure in the surgical group when compared to controls (p = 0.019). Voiding cystourethrography and bladder inspection demonstrated an anterior flap valve with no fistula formation in all animals. Histological examination showed a viable anterior bladder wall flap in all cases. This technique was then applied to 6 patients with neurogenic bladder and low urethral resistance that failed to resolve with medical treatment. Urinary continence was achieved in 4 patients. In 1 patient a vesicourethral fistula developed 3 months postoperatively, since the mother failed to catheterize for 12 hours. This technique is a useful alternative in the treatment of urinary incontinence.
尿道不规则（妨碍导尿）和无法实现控尿是尿失禁手术中常见的并发症。我们描述了一种手术技术，即使用前膀胱壁瓣以覆盖方式缝合到后壁，形成瓣阀机制。在犬类身上进行的实验工作表明，与对照组相比，手术组的漏点压力显著增加（p = 0.019）。排尿性膀胱尿道造影和膀胱检查显示，所有动物的前瓣阀均未形成瘘管。组织学检查显示，所有病例的前膀胱壁瓣均存活。然后将该技术应用于6例药物治疗无效的神经源性膀胱和低尿道阻力患者。4例患者实现了尿失禁。1例患者术后3个月出现膀胱尿道瘘，原因是母亲12小时未进行导尿。该技术是治疗尿失禁的一种有用的替代方法。
