CAJ | 학술논문

目的探讨不同球部尿道悬吊术式治疗男性获得性尿失禁的疗效. 方法回顾性分析2000年10月至2013年6月105例采用3种不同术式在尿动力监测下行球部尿道悬吊术治疗男性获得性尿失禁患者的资料.患者年龄15～81岁,平均54岁.尿失禁病因分别为前列腺术后70例和后尿道狭窄术后35例.术前完全性尿失禁10例,压力性尿失禁95例.尿失禁病史1～12年,平均3年.术式为复合吊带悬吊54例,经闭孔吊带悬吊41例,带筋膜腹直肌瓣悬吊10例. 结果本组患者术后随访3～ 128个月,平均54个月.103例于术后第5～7天拔除导尿管,5例出现排尿困难,4例再次留置导尿1周后排尿通畅,1例经膀胱颈部电切后排尿通畅；余2例手术结束时尿道压分别为110和158 cm H2O(1 cm H2O=0.098 kPa),术后分别留置导尿管2周和3周,拔除导尿管后排尿通畅和完全控尿.本组治愈74例,治愈率为70.5％ (74/105),其中前列腺术后患者治愈率达81.4％(57/70),后尿道狭窄术后患者治愈率为48.6％(17/35)；改善26例,无效5例. 结论尿动力监测下球部尿道悬吊术是治疗男性获得性尿失禁的有效方法,尤其适合前列腺术后尿失禁患者.
목적 탐토불동구부뇨도현조술식치료남성획득성뇨실금적료효. 방법 회고성분석2000년10월지2013년6월105례채용3충불동술식재뇨동력감측하행구부뇨도현조술치료남성획득성뇨실금환자적자료.환자년령15～81세,평균54세.뇨실금병인분별위전렬선술후70례화후뇨도협착술후35례.술전완전성뇨실금10례,압력성뇨실금95례.뇨실금병사1～12년,평균3년.술식위복합조대현조54례,경폐공조대현조41례,대근막복직기판현조10례. 결과 본조환자술후수방3～ 128개월,평균54개월.103례우술후제5～7천발제도뇨관,5례출현배뇨곤난,4례재차류치도뇨1주후배뇨통창,1례경방광경부전절후배뇨통창；여2례수술결속시뇨도압분별위110화158 cm H2O(1 cm H2O=0.098 kPa),술후분별류치도뇨관2주화3주,발제도뇨관후배뇨통창화완전공뇨.본조치유74례,치유솔위70.5％ (74/105),기중전렬선술후환자치유솔체81.4％(57/70),후뇨도협착술후환자치유솔위48.6％(17/35)；개선26례,무효5례. 결론 뇨동력감측하구부뇨도현조술시치료남성획득성뇨실금적유효방법,우기괄합전렬선술후뇨실금환자.
Objective To explore the efficacy of different bulbourethral sling procedures in the treatment of male acquired urinary incontinence.Methods A retrospective study of 105 patients with acquired urinary incontinence was performed.The patients underwent 3 different bulbourethral sling procedures under urodynamic monitoring between October 2000 and June 2013.Mean age was 54 years (range 15-81).Urinary incontinence was secondary to post-prostatectomy in 70 patients and posterior urethroplasty in 35.Preoperatively,10 patients were completely urinary incontinence and 95 patients were stress urinary incontinence.Mean duration of urinary incontinence was 3 years (1-12).The surgical techniques were composite device suspension in 54 patients,pedicled rectus abdominalis muscle and fascial flaps suspension in 10 and transobturator sling in 41.Results The patients were followed up for 3-128 months (mean 54 months).The urethral catheter was left in situ for 5-7 days in 103 patients.Of the 103 patients,5 patients were difficulty in voiding but corrected by indwelling of urethral tube for another 1 week in 4 patients and transurethral bladder neck resecting in 1.In the remainder 2 patients,the maximum urethral pressure was 110 and 158 cm H2O (1 cm H2O=0.098 kPa) at the end of surgery and both patients were able to void on day 14 and 21 respectively and achieved complete continence.In this study,complete continence was achieved with good voiding in 74 patients (70.5％),completed control of urination rate was 81,4％ (57/70) in group of prostate and 48.6％ (17/35) in group of posterior urethroplasty.Twenty-six patients were improved and 5 patients were failed.Conclusion Bulbourethral sling procedure under urodynamic monitoring is an effective option in the treatment of male acquired urinary incontinence,especially for patients of incontinence of post-prostatectomy.