Appell R A, Rackley R R, Dmochowski R R
Section of Voiding Dysfunction and Female Urology, Cleveland Clinic Foundation, OH, USA.
J Endourol. 1996 Jun;10(3):221-5. doi: 10.1089/end.1996.10.221.
The Vesica percutaneous bladder neck stabilization (PBNS) represents a minimally invasive surgical procedure for the treatment of stress incontinence caused by hypermobility of the proximal urethra and bladder neck. Since the initial description of the procedure, technique and instrumentation modifications have added to the reproducibility of this operation. Three specific modifications have been incorporated: strong attachment of the stabilization suture to the pubic bone utilizing a bone anchor; incorporation of a full-thickness broad segment of tissue including the endopelvic, pubocervical, and subvaginal fascia as well as vaginal wall in a Z suture; and loose resuspension of the proximal urethra to stabilize the continence mechanism. Cystoscopic verification of suture location precludes bladder entry or distal suture placement. This procedure has been utilized in 71 women with an overall cure rate (no stress incontinence) of 94% at follow-up of 12 months. One retropubic abscess required drainage, and a second patient required excision of a skin sinus tract caused by an infected bone anchor. Urinary retention longer than 3 weeks has not been encountered. Overall morbidity has been minimal. Long-term follow-up of continence status and other procedure-related complications is ongoing. The PBNS provides continence results and complication rates equivalent to those of other retropubic and transvaginal procedures using a minimally invasive outpatient technique.
经皮膀胱颈稳定术（PBNS）是一种微创手术，用于治疗由近端尿道和膀胱颈活动过度引起的压力性尿失禁。自该手术首次被描述以来，技术和器械的改进提高了该手术的可重复性。已纳入三项具体改进：使用骨锚将稳定缝线牢固地附着于耻骨；在Z形缝合法中纳入包括盆腔内筋膜、耻骨宫颈筋膜、阴道筋膜以及阴道壁在内的全层宽组织段；近端尿道轻度重新悬吊以稳定控尿机制。通过膀胱镜检查缝线位置可避免膀胱穿孔或远端缝线放置不当。该手术已应用于71名女性患者，在12个月的随访中总体治愈率（无压力性尿失禁）为94%。1例耻骨后脓肿需要引流，另1例患者需要切除由感染的骨锚引起的皮肤窦道。未出现超过3周的尿潴留。总体并发症发生率很低。目前正在对控尿状态和其他与手术相关的并发症进行长期随访。PBNS使用微创门诊技术，其控尿效果和并发症发生率与其他耻骨后和经阴道手术相当。
