Schultheiss D, Höfner K, Oelke M, Grünewald V, Jonas U
Department of Urology, Medizinische Hochschule Hannover, Germany.
Br J Urol. 1998 Aug;82(2):192-5. doi: 10.1046/j.1464-410x.1998.00691.x.
To evaluate the outcome of a new modification of percutaneous needle suspension, using a bone anchor system for fixing the suture at the public bone, and to compare the results with those published previously.
From March 1996, 37 patients with stress urinary incontinence (> 2 years) were treated using a bone anchor system. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad 'Z'-stitch. A urodynamic investigation performed preoperatively in all patients confirmed stress incontinence and excluded detrusor instability. The outcome was assessed by either by a clinical follow-up investigation or using a standardized questionnaire, over a mean follow-up of 11 months (range 6-18).
In the 37 patients, the procedure was successful in 25 (68%), with 16 (43%) of the patients completely dry and nine (24%) significantly improved. Removal of the bone anchor and suture was necessary in two patients, because of unilateral bacterial infection in one and a bilateral soft tissue granuloma in the other. One bone anchor became dislocated in a third patient. In two cases where the treatment failed, new detrusor instability was documented urodynamically. Minor complications were prolonged wound pain in 10 (26%) and transient urinary retention or residual urine in 12 patients (32%).
The poor success rate in the study corresponds with the long-term results of conventional or modified needle suspension procedures and does not reinforce the optimistic results of bone anchoring published recently. Because of the poorer long-term results from percutaneous needle suspension than from other techniques of open retropubic bladder neck suspension, it remains questionable whether percutaneous needle suspension should be considered a first-line procedure for the treatment of female stress urinary incontinence.
评估一种经皮穿刺悬吊术的新改良方法的效果，该方法使用骨锚系统将缝线固定于耻骨，同时将结果与先前发表的结果进行比较。
自1996年3月起，37例压力性尿失禁（病程超过2年）患者接受了骨锚系统治疗。每侧通过宽“Z”形缝线将缝线固定于耻骨宫颈筋膜和阴道壁。所有患者术前均进行了尿动力学检查，证实为压力性尿失禁并排除逼尿肌不稳定。通过临床随访调查或使用标准化问卷对结果进行评估，平均随访11个月（范围6 - 18个月）。
37例患者中，25例（68%）手术成功，其中16例（43%）患者完全干爽，9例（24%）明显改善。2例患者因单侧细菌感染（1例）和双侧软组织肉芽肿（另1例）需要取出骨锚和缝线。第3例患者出现1个骨锚脱位。2例治疗失败的病例经尿动力学检查发现新的逼尿肌不稳定。轻微并发症包括10例（26%）伤口疼痛持续时间延长，12例（32%）患者出现短暂性尿潴留或残余尿。
本研究中的低成功率与传统或改良穿刺悬吊术的长期结果相符，并未证实近期发表的骨锚固定术的乐观结果。由于经皮穿刺悬吊术的长期效果不如其他开放性耻骨后膀胱颈悬吊术，经皮穿刺悬吊术是否应被视为女性压力性尿失禁的一线治疗方法仍值得怀疑。
