Dmochowski R R, Appell R A
Department of Urology, University of Tennessee, Memphis 38163, USA.
Tech Urol. 1996 Fall;2(3):147-53.
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 into this procedure: strong anchoring of the suspension suture to the symphysis pubis using a bone anchor, incorporation of a broad segment of vaginal wall with a Z suture, and loose resuspension of the proximal urethra. Cystoscopic verification of suture location precludes bladder entry or distal suture placement. This procedure has been currently used in 71 women with an overall cure rate of 94% (no stress incontinence) at follow-up of 12 months. One retropubic abscess required drainage. A second patient required excision of a skin sinus tract cause by an infected bone anchor. Urinary retention of > 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. PBNS provides equivalent continence results and complication rates as compared with other retropubic and transvaginal procedures with a minimally invasive outpatient technique.
经皮膀胱颈固定术（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。该手术纳入了三项具体改进：使用骨锚将悬吊缝线牢固地固定在耻骨联合上，采用Z形缝线纳入宽段阴道壁，以及对近端尿道进行宽松的重新悬吊。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。目前，该手术已应用于71名女性患者，在12个月的随访中，总体治愈率为94%（无压力性尿失禁）。有1例耻骨后脓肿需要引流。另1例患者因骨锚感染导致皮肤窦道形成，需要切除。未出现超过3周的尿潴留。总体发病率极低。目前正在对尿失禁状态和其他与手术相关的并发症进行长期随访。与其他耻骨后和经阴道手术相比，PBNS以微创门诊技术提供了相当的尿失禁治疗效果和并发症发生率。
