Elsharaby M, Abo-Farha O, Rasheed M, Omar A, Elgamasy A, Ghoniem G
Department of Urology, Tanta University, Egypt.
J Urol. 1996 Dec;156(6):1972-4.
Because of the complexity of reconstructive surgical techniques, the high failure rate and cost of the devices used, as well as the associated mechanical malfunctions there is need for an alternative operation to treat post-prostatectomy urinary incontinence. We present a new procedure along with promising results in cases of simple post-prostatectomy incontinence after transurethral resection of the prostate or open prostatectomy.
The principles of our technique include lysis of the pelvic urethra with preservation of the neurovascular bundle, as well as suspension of the prostatic capsule to the anterior abdominal wall. With this technique we corrected post-prostatectomy sphincteric incompetence in 21 patients. Preoperative evaluation included physical examination, excretory urography, ascending urethrocystography and urethrocystoscopy. Urodynamic investigations included uroflowmetry, cystometrography and urethral pressure profilometry. The patients were reevaluated radiologically and urodynamically 3 months postoperatively. Mean followup was 19 months.
All patients tolerated the procedure well. Few intraoperative and postoperative complications were encountered. The success rate was 81% and these 17 patients became continent day and night.
Our procedure combines the continence enhancing features of pelvic urethral elongation, urethral suspension, angulation of the prostatomembranous junction and prostatic fixation. The preliminary success rate of this technique is encouraging. However, larger numbers of patients and long-term followup are needed to confirm our findings.
由于重建手术技术复杂、所用器械故障率高且成本高昂，以及相关的机械故障，需要一种替代手术来治疗前列腺切除术后尿失禁。我们介绍了一种新手术方法，并展示了经尿道前列腺切除术或开放性前列腺切除术后单纯前列腺切除术后尿失禁病例的良好结果。
我们技术的原则包括松解盆腔尿道并保留神经血管束，以及将前列腺包膜悬吊至前腹壁。我们用这种技术纠正了21例患者的前列腺切除术后括约肌功能不全。术前评估包括体格检查、排泄性尿路造影、逆行尿道膀胱造影和尿道膀胱镜检查。尿动力学检查包括尿流率测定、膀胱测压和尿道压力测定。术后3个月对患者进行放射学和尿动力学复查。平均随访19个月。
所有患者对手术耐受良好。术中及术后并发症极少。成功率为81%，这17例患者日夜均能控制排尿。
我们的手术结合了盆腔尿道延长、尿道悬吊、前列腺膜部交界处成角和前列腺固定等增强控尿的特点。该技术的初步成功率令人鼓舞。然而，需要更多患者和长期随访来证实我们的发现。
