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目的探讨尿道压监测下球部尿道悬吊术治疗男性获得性尿失禁的疗效。方法2000年10月至2004年9月收治男性获得性尿失禁25例,年龄18~81岁,平均66岁。其中后尿道狭窄行尿道成形术后6例,根治前列腺切除术后4例,良性前列腺增生(BPH)行经尿道前列腺电切术(TURP)后6例,BPH行前列腺摘除术后9例。尿失禁病程1~12年,平均4年。完全性尿失禁8例,压力性尿失禁17例,需尿垫1~5块/d,平均3块/d。术前均经盆底肌锻炼无效。尿动力学检查平均最大尿道压52 cm H2O(1 cm H2O=0.098 kPa)。平均功能性尿道长度1.4 cm。均在尿道压监测下行球部尿道悬吊术。结果手术结束时平均尿道压96 cm H2O,平均功能性尿道长度3.5 cm。术后完全控尿21例,尿失禁改善3例,排尿困难1例,经膀胱颈部电切后排尿通畅。术后1个月B超检查剩余尿均<20 m l;23例平均最大尿流率15 m l/s。随访1年以上22例,1例于术后2年死于脑溢血,2例于术后1年和2年压力性尿失禁复发,其余19例排尿和控尿良好。结论尿道压监测下球部尿道悬吊术是治疗男性尿失禁的有效方法。
Objective To investigate the curative effect of urethral suspension under urethral pressure in treating male acquired urinary incontinence. Methods From October 2000 to September 2004, 25 cases of male acquired incontinence were admitted, aged 18-81 years, with an average of 66 years. Among them, 6 cases underwent urethroplasty in the posterior urethral stricture, 4 cases after radical prostatectomy, 6 cases after benign prostatic hyperplasia (BPH) after transurethral resection of prostate (TURP) and 9 cases after BPH underwent prostatectomy. Urinary incontinence duration of 1 to 12 years, an average of 4 years. 8 cases of complete urinary incontinence, 17 cases of stress urinary incontinence, need urinary pad 1 ~ 5 blocks / d, an average of 3 / d. Preoperative pelvic floor muscle exercises are invalid. Urodynamic examination average maximum urethral pressure 52 cm H2O (1 cm H2O = 0.098 kPa). The average functional urethral length of 1.4 cm. Urinary tract pressure were measured in the downlink ball urethral suspension. Results At the end of surgery, the average urethral pressure was 96 cm H2O and the average functional urethral length was 3.5 cm. Complete control of urine after surgery in 21 cases, 3 cases of urinary incontinence improvement, dysuria in 1 case, after voiding of the bladder neck after tamponomy. One month after operation, residual urine in B-mode ultrasound was less than 20 m l; mean maximum flow rate in 23 cases was 15 m l / s. Followed up for more than one year in 22 cases, 1 case died of cerebral hemorrhage 2 years after surgery, 2 cases of recurrent urinary incontinence 1 year and 2 years after operation, and the remaining 19 cases of urination and urine control were good. Conclusions Urethral pressure monitoring of the ball urethral suspension is an effective method to treat male urinary incontinence.