Gosálbez R, Castellán Y M
Departamento de Urología, Universidad de Miami, Jackson Memorial Hospital, Florida, USA.
Arch Esp Urol. 1998 Jul-Aug;51(6):595-603.
The selection of patients amenable to treatment with a bladder neck sling remains a controversy. In this paper we review our experience with this technique and describe our patient selection criteria.
Since 1991, 30 patients (24 females and 6 males) aged 4 to 20 years (mean 10) received a bladder neck sling as part of the surgical treatment for their urinary incontinence. The cause of incontinence was neurogenic in 28 of the 30 patients. The 6 male patients were prepuberal. All patients had a preoperative video urodynamic study. The criteria for increasing cervico-urethral resistance included a passive leak point pressure of < 50 cm H2O, stress leak point pressure of < 100 cm H2O, radiological evidence of an open bladder neck and stress incontinence regardless of the other urodynamic and radiologic parameters. The technical aspects of the procedure are described in detail. Augmentation cystoplasty was performed concomitantly in 29 patients.
Patient follow-up ranged from 2 to 70 months (mean 37.6). Twenty-eight patients (93%) were continent postoperatively. Two female patients remained incontinent at low leak point pressures. All patients emptied the bladder by intermittent catheterization. Twelve patients perform catheterization through the urethra without difficulty.
The rectus fascia sling has several advantages over other surgical methods for increasing the cervico-urethral resistance. It is simple, effective, low-cost and has a low complication rate. In our view, the sling is the technique of choice for increasing cervico-urethral resistance in female and prepuberal male patients requiring a cystoplasty concomitantly.
选择适合接受膀胱颈悬吊术治疗的患者仍然存在争议。在本文中，我们回顾了我们在这项技术上的经验，并描述了我们的患者选择标准。
自1991年以来，30例年龄在4至20岁（平均10岁）的患者（24名女性和6名男性）接受了膀胱颈悬吊术，作为其尿失禁手术治疗的一部分。30例患者中有28例尿失禁的原因是神经源性的。6名男性患者为青春期前。所有患者术前均进行了视频尿动力学检查。增加宫颈尿道阻力的标准包括被动漏点压<50 cm H2O、应力漏点压<100 cm H2O、膀胱颈开放的放射学证据以及压力性尿失禁，无论其他尿动力学和放射学参数如何。详细描述了该手术的技术细节。29例患者同时进行了膀胱扩大术。
患者随访时间为2至70个月（平均37.6个月）。28例患者（93%）术后控尿。两名女性患者在低漏点压时仍有尿失禁。所有患者均通过间歇性导尿排空膀胱。12例患者经尿道导尿无困难。
与其他增加宫颈尿道阻力的手术方法相比，腹直肌筋膜悬吊术有几个优点。它简单、有效、成本低且并发症发生率低。我们认为，对于需要同时进行膀胱扩大术的女性和青春期前男性患者，悬吊术是增加宫颈尿道阻力的首选技术。
