Kawakami S, Yamada T, Watanabe T, Masuda H, Nagamatsu H, Nagahama K, Negishi T
Department of Urology, Kasukabe Municipal Hospital.
Nihon Hinyokika Gakkai Zasshi. 1994 Jul;85(7):1066-71. doi: 10.5980/jpnjurol1989.85.1066.
We treated 42 females (26 with genuine stress urinary incontinence, 13 with incontinence and cystocele, and 3 with cystocele) with bladder neck suspension using transrectal ultrasonography during operation. The optimum tightness of suspension was decided by adjusting the posterior urethrovesical angle to about 90 degrees in 26 patients with genuine stress urinary incontinence accompanied with flattened posterior urethrovesical angles and by adjusting the angle of inclination of the upper urethra to about 10 degrees in 16 patients with cystocele accompanied with rotationally descended urethra. Urinary continence was achieved in 35 of 39 patients presenting with urinary incontinence. Three patients with cystocele without urinary incontinence remained dry after the operation. The average of maximum urinary flow rate significantly increased after operation. The angles of inclination of the upper urethra measured on the ultrasonogram during operation corresponded well with those measured on the post-operative lateral urethrocystogram. In 26 patients without cystocele, the angles of inclination of the upper urethra and the posterior urethrovesical angles were correlated significantly on the pre-operative urethrocystograms. Roentgenographic changes in pre- and post-operative urethrocystograms showed concomitant restoration in the angles of inclination of the upper urethra and in the posterior urethrovesical angles as well as significant elevation of the bladder neck. Present results indicate that the angles of inclination of the upper urethra measured by transrectal ultrasonography during operation as well as the posterior urethrovesical angles are useful and reliable to decide the optimum tightness of bladder neck suspension for the patients with stress urinary incontinence accompanied with rotationally descended urethra.(ABSTRACT TRUNCATED AT 250 WORDS)
我们在手术过程中使用经直肠超声对42例女性患者（26例真性压力性尿失禁、13例尿失禁合并膀胱膨出、3例膀胱膨出）进行膀胱颈悬吊术。对于26例真性压力性尿失禁且膀胱后尿道角变平的患者，通过将后尿道膀胱角调整至约90度来确定悬吊的最佳紧度；对于16例膀胱膨出且尿道旋转下降的患者，通过将上尿道倾斜角调整至约10度来确定悬吊的最佳紧度。39例尿失禁患者中有35例实现了尿控。3例无尿失禁的膀胱膨出患者术后仍无尿失禁。术后最大尿流率平均值显著增加。手术中超声测量的上尿道倾斜角与术后尿道膀胱侧位造影测量的角度吻合良好。在26例无膀胱膨出的患者中，术前尿道膀胱造影显示上尿道倾斜角与后尿道膀胱角显著相关。术前和术后尿道膀胱造影的X线变化显示上尿道倾斜角和后尿道膀胱角同时恢复，膀胱颈显著抬高。目前的结果表明，手术中经直肠超声测量的上尿道倾斜角以及后尿道膀胱角对于确定伴有尿道旋转下降的压力性尿失禁患者膀胱颈悬吊的最佳紧度是有用且可靠的。（摘要截短至250字）
