Kropp B P, Rink R C, Adams M C, Keating M A, Mitchell M E
Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis 46202.
J Urol. 1993 Aug;150(2 Pt 2):703-4. doi: 10.1016/s0022-5347(17)35591-x.
The placement of a 1.5 cm. wide silicone sheath around a newly constructed urethra/bladder neck to ensure maintenance of repair length and to facilitate future placement of a sphincter cuff was reported by our institution in 1985. We present our long-term followup and new recommendations for use of the silicone sheath. A total of 15 silicone sheaths was placed between March 1981 and July 1984. Of the sheaths 14 were placed at the time of urinary reconstruction around the Young-Dees-Leadbetter bladder neck repair and 1 was placed after erosion of an artificial urinary sphincter cuff. Of the 15 sheaths 10 have eroded into the urethra and 4 sheaths remain in situ. Another sheath was replaced 2 years after its original insertion with an artificial urinary sphincter cuff. Mean time to erosion was 48.2 months, with a range of 2 to 108 months. Long-term followup of 10 patients revealed that 4 ultimately required ligation of the bladder neck and construction of continent stoma after erosion, 1 is dry after placement of a bulbar artificial urinary sphincter, 2 remain dry after removal of the eroded sheath alone, 2 required bladder neck revision to achieve continence after erosion and the most recent patient remains diverted with a suprapubic tube. All 4 patients with sheaths still remaining are dry without evidence of erosion (mean duration 116 months). These long-term results using a silicone wrap around a newly constructed bladder neck reveal an unacceptably high rate of erosion. Therefore, we no longer recommend or support the use of the silicone sheath in the manner we have described for bladder neck reconstruction.
1985年，我们机构报告了在新建尿道/膀胱颈周围放置一个1.5厘米宽的硅胶鞘，以确保修复长度的维持，并便于未来放置括约肌套囊。我们展示了我们对硅胶鞘使用的长期随访及新建议。1981年3月至1984年7月期间共放置了15个硅胶鞘。其中14个在Young-Dees-Leadbetter膀胱颈修复的尿道重建时放置，1个在人工尿道括约肌套囊侵蚀后放置。15个鞘中，10个已侵蚀入尿道，4个仍在位。另一个鞘在最初插入2年后被人工尿道括约肌套囊替换。侵蚀的平均时间为48.2个月，范围为2至108个月。对10例患者的长期随访显示，4例最终在侵蚀后需要结扎膀胱颈并构建可控性造口，1例在放置球部人工尿道括约肌后无尿失禁，2例仅在移除侵蚀的鞘后仍无尿失禁，2例在侵蚀后需要进行膀胱颈修复以实现控尿，最近的1例患者仍通过耻骨上管引流尿液。所有4个仍在位的鞘的患者均无尿失禁且无侵蚀迹象（平均持续时间116个月）。这些围绕新建膀胱颈使用硅胶包裹的长期结果显示侵蚀率高得令人无法接受。因此，我们不再推荐或支持按我们所描述的方式在膀胱颈重建中使用硅胶鞘。
