Harriss D R, Iacovou J W, Lemberger R J
Department of Urology, City Hospital NHS Trust, Nottingham, UK.
Br J Urol. 1996 Nov;78(5):722-5; discussion 726-8. doi: 10.1046/j.1464-410x.1996.17510.x.
To establish the safety and efficacy of the periurethral injection of silicone microimplants (Macroplastique) for the treatment of genuine stress incontinence in women.
Forty women (median age 50 years, range 27-74) with genuine stress incontinence confirmed on medium-fill video-cystometry were recruited to the study. Macroplastique (3-7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points 'around the clock' under cystoscopic control. Where possible, the urodynamic study was repeated after 3 months. Results were graded as excellent (dry, no protection), good (better, but not totally dry) or poor (no improvement).
Three months after a single injection, 16 (40%) were completely dry, 13 (33%) were improved and 11 (27%) were no better. Four patients who were improved were rendered dry by a second injection. After 3 years, 16 (40%) remained completely dry, seven (18%) were improved and 17 (42%) required alternative treatment with a Stamey bladder neck suspension. Dysuria for 48 h occurred in almost all patients; two were catheterized overnight and one required a catheter for 6 weeks. A comparison of maximum voiding pressures and flow rates before and 3 months after a single injection of Macroplastique revealed no urodynamic evidence of obstructed voiding (n = 25).
Injectable silicone microimplants produced a good to excellent result in 73% of patients in the short-term and 58% of women maintained this response after 3 years. The injection is a day-case procedure which provides a satisfactory medium-term outcome in over half of patients with genuine stress incontinence. There are few side-effects and those patients with no improvement may go on to be treated by open surgery without complication.
确定经尿道周围注射硅酮微植入物（Macroplastique）治疗女性真性压力性尿失禁的安全性和有效性。
招募了40名经中度充盈膀胱测压证实为真性压力性尿失禁的女性（中位年龄50岁，范围27 - 74岁）参与本研究。在膀胱镜控制下，于膀胱颈远端1厘米处经尿道周围“全天候”分三到四点注射Macroplastique（3 - 7毫升）。尽可能在3个月后重复进行尿动力学研究。结果分为优秀（干爽，无需防护）、良好（有所改善，但未完全干爽）或差（无改善）。
单次注射3个月后，16例（40%）完全干爽，13例（33%）有所改善，11例（27%）无改善。4例有所改善的患者经第二次注射后变为干爽。3年后，16例（40%）仍完全干爽，7例（18%）有所改善，17例（42%）需要采用斯塔米膀胱颈悬吊术进行替代治疗。几乎所有患者均出现了48小时的排尿困难；2例患者夜间留置导尿管，1例患者需要留置导尿管6周。单次注射Macroplastique前后3个月的最大排尿压力和流速比较显示，无尿动力学证据表明存在排尿梗阻（n = 25）。
可注射硅酮微植入物在短期内使73%的患者取得了良好至优秀的效果，3年后58%的女性维持了这一效果。该注射为日间手术，为超过半数的真性压力性尿失禁患者提供了令人满意的中期疗效。副作用很少，未改善的患者可继续接受开放手术治疗且无并发症。
