球部尿道包埋术治疗前列腺术后尿失禁

目的 :介绍并评价球部尿道包埋术治疗前列腺术后尿失禁临床疗效。　方法 :6例前列腺术后尿失禁超过 2 0个月者经保守治疗无效后接受该手术。球部尿道包埋于两阴茎海绵体之间 ,使球部尿道转位到阴茎海绵体背侧。结果 :经 9个月至 6年的随访 ,5例一次手术成功、尿控满意 ,另 1例再行 2次加长包埋后症状明显改善。　结论 :前列腺手术损伤内、外括约肌时可致尿失禁 ,保守治疗 12个月无效时可手术。球部尿道包埋术创伤小、操作简便、疗效可靠 ,但包埋力量大小尚待进一步探索。     

球部尿道悬吊术治疗男性尿失禁的探讨

目的：探讨球部尿道悬吊术对男性后尿道成形术后和前列腺切除术后尿失禁的治疗效果。方法：从手术方法和术后尿动力学指标及临床效果方面,对采用球部尿道悬吊术治疗的男性尿失禁12例病例作回顾性分析。结果：术后10例完全控制排尿,1例改善,1例出现排尿困难,经膀胱颈部电切后排尿通畅。尿动力学检查示最大尿道压85－115cmH2O(1cmH2O=0.098kPa),平均98cmH2O;功能性尿道长度3．5－4．5cm,平均3．8cm.结论:球部尿道悬吊术是治疗男性后尿道成形术后和前列腺切除术后尿失禁的有效方法.     

男性获得性尿失禁治疗的临床研究

目的探讨尿道压监测下球部尿道复合悬吊术和带蒂腹直肌瓣球部尿道包绕术治疗男性获得性尿失禁的疗效。方法2000年10月至2007年12月对44例男性获得性尿失禁患者,40例行心脏涤纶补片和尼龙线＋TVT吊带球部尿道复合悬吊术,其中前列腺术后30例,后尿道手术后10例;完全性尿失禁11例,压力性尿失禁29例。另4例复杂性后尿道狭窄术后患者,行带蒂腹直肌瓣球部尿道包绕术。结果复合悬吊术组术后平均随访37（3-75）个月,完全控尿31例,尿失禁改善7例,无效2例;排尿困难1例,经膀胱颈部电切后排尿通畅。行带蒂腹直肌瓣球部尿道包绕术的4例患者,2例治愈,2例控尿功能有明显改善。结论尿道压监测下心脏涤纶补片和尼龙线＋TVT吊带球部尿道复合悬吊术和带蒂腹直肌瓣球部尿道包绕术是治疗男性尿失禁的有效方法。     

尿道压监测下球部尿道悬吊术治疗男性获得性尿失禁

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lO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52cm H2O（1cm H2O=0．098kPa）。平均功能性尿道长度1．4cm。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96cm H2O，平均功能性尿道长度3．5cm。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〈20ml；23例平均最大尿流率15ml／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。     

经尿道前列腺电切术后常见并发症的总结

目的探讨经尿道前列腺切除术后常见并发症的原因、预防和处理方法。方法经尿道前列腺电讪小治疗良性前列腺增生症65例，出现并发症8例，对其临床资料进行分析。结果术中严重出血1例，中转开放手术治愈。尿潴留2例，1例再次行前列腺电切术后排尿通畅，1例作尿道扩张术及口服对症药物治疗后排尿正常。尿道狭窄4例，定期尿道扩张1个月，排尿顺畅。尿失禁1例，用阴茎夹控制排尿。结论严格掌握手术指征，术中认真止血，尽可能切除前列腺，避免损伤尿道膜部括约肌是预防上述并发症的关键。     

球部尿道悬吊治疗前列腺切除术后尿失禁

目的　探讨球部尿道悬吊术治疗前列腺切除术后尿失禁的疗效。　方法　前列腺切除术后尿失禁患者 5例 ,病史 2～ 10年。 1例完全性尿失禁 ,4例每天需尿垫 2～ 5块。在尿动力学检查仪监测下采用球部尿道悬吊术治疗。　结果　 4例术后能完全控制尿 ,无排尿困难 ;1例术后出现排尿困难 ,经膀胱颈部电切后排尿通畅。　结论　球部尿道悬吊术是治疗前列腺切除术后尿失禁的有效方法。     

保留前叶的经尿道前列腺切除术及解剖学依据

目的：评价保留前叶的经尿道前列腺切除术的疗效及其对术后尿失禁的避免作用,并初步探讨本术式的解剖学依据。方法：在86例BPH患者中,32例行保留前叶的经尿道前列腺切除术（1组）,54例行传统的经尿道前列腺切除术（2组）;并对比两组各临床参数,结合尿道括约肌的解剖学特征进行分析。结果：1组术后排尿通畅,剩余尿量均小于5ml,无尿失禁发生。2组中有29例发生各种尿失禁。1组术后后尿道长度大于2组。结论：保留前叶的经尿道前列腺切除术疗效满意,并可有效避免对前列腺前方尿道括约肌的损伤,在一定程度上保留后尿道长度,从而有效避免术后尿失禁的发生。     

经尿道前列腺切除术后并发症14例分析

目的探讨经尿道前列腺切除术后常见并发症的原因、预防和处理方法。方法2002年8月～2005年8月。我院经尿道前列腺电切术、经尿道前列腺电汽化术治疗良性前列腺增生症73例，出现14例并发症，包括术中严重出血2例，术后尿潴留5例，尿道狭窄2例，尿失禁2例，包膜穿孔致电切综合征2例，下肢深静脉血栓1例。结果1例严重出血者中转开放手术，无再次出血；1例经放置三腔单囊尿管，持续盐水或冰盐水膀胱冲洗，配合止血药物治疗，也未再次发生出血，术后排尿顺畅。5例术后尿潴留，其中2例再次经尿道前列腺电切手术，3例经尿道扩张术结合口服对症药物，5例均无再次尿潴留，术后1—3个月复查，尿流率〉15ml／s。2例尿道外口狭窄者定期尿道扩张1个月，排尿顺畅。2例尿失禁行永久膀胱造瘘术。2例包膜穿孔致电切综合征经迅速结束手术，积极对症治疗，生命体征平稳，术后排尿顺畅。1例下肢深静脉血栓2周后治愈。结论尿潴留、尿道狭窄是经尿道前列腺切除术后常见并发症，严格掌握手术指征，熟练细致地操作，及时有效地处理可以避免出现严重后果。     

经尿道前列腺汽化电切术后尿道狭窄的防治

目的 探讨经尿道前列腺汽化电切(TVP)术后尿道狭窄的防治。方法 统计分析TVP病例中尿道狭窄的发生率和防治方法。3012例患者中，术后4周-22个月发生尿道狭窄95例，占3．15％。年龄55—85岁，平均68．7岁。前尿道狭窄47例(49．5％)，后尿道狭窄31例(32．6％)，膀胱颈挛缩或闭锁17例(17．9％)。结果 95例患者术后随访4～36个月，平均14个月。行单纯尿道扩张术65例，治愈59例(90．8％)，失败6例改尿道内切开术；尿道内切开加尿道扩张术19例，治愈13例(68．4％)，失败6例改尿道成形术；膀胱颈部闭锁或挛缩者17例，作膀胱颈部凿通和电切术，治愈15例(88．2％)，失败2例。结论 尿道狭窄为TVP术后常见并发症，术后定期密切随访和早期治疗是治愈的关键。     

男性球海绵体悬吊术治疗前列腺术后尿失禁的探讨

目的：探讨男性球海绵体悬吊术治疗前列腺切除术（包括根治性切除术）后尿失禁的疗效。方法：采用经尿道球海绵体悬吊术治疗前列腺切除术后严重尿失禁患者7例。结果：术后随访14-26个月（平均20.4个月）,6例患者完全自控排尿,1例改善非常明显。结论：男性球海绵体悬吊术是治疗根治性前列腺切除或其他原因引起尿道括约肌损伤所致尿失禁的理想方法。     

Long-term results of the bulbourethral sling procedure

PURPOSE: We evaluated the long-term efficacy of the male bulbourethral sling procedure in the treatment of post-radical prostatectomy urinary incontinence. MATERIALS AND METHODS: Between October 1994 and June 2000, 95 patients with post-radical prostatectomy incontinence underwent bulbourethral sling placement with tetrafluoroethylene bolsters at our hospital. Ultimately 71 of these patients responded to our questionnaire and they were classified into 2 groups. Group 1 consisted of 62 patients who had not undergone prior radiation therapy and group 2 consisted of 9 who had undergone radiation therapy before the sling procedure. Patients were asked to respond to questions regarding continence status as well as the validated Incontinence Quality of Life and International Prostate Symptom Score questionnaires. RESULTS: Mean followup from the most recent sling procedure was 4 years (range 0.27 to 6.55). Average patient age at questionnaire response was 74 years. A total of 86 procedures were performed on 71 patients. Of the 71 patients 7 underwent either sling removal or artificial urinary sphincter placement and were excluded from questionnaire analysis. Including retightening procedures 68% of the patients (72% of group 1, 43% of group 2) required 2 or less pads daily. Of the patients 36% (42% of group 1 and 14% of group 2) required 0 pads. CONCLUSIONS: The male bulbourethral sling procedure remains an effective treatment for post-prostatectomy incontinence at 4-year followup.     

Incontinence after radical prostatectomy: pathophysiology and management

Despite improvements in surgical technique designed to preserve the functional integrity of the urethral sphincteric mechanism, incontinence after radical prostatectomy still occurs in many patients. Most patients have stress incontinence secondary to intrinsic sphincter deficiency, but many also have bladder dysfunction. The treatment of choice for post-prostatectomy stress incontinence is the artificial urinary sphincter. Other treatment options include collagen injection therapy and the male bulbourethral sling.     

Readjustable transobturator sling: a novel sling procedure for male urinary incontinence

Post-prostatectomy incontinence remains a significant problem for both patients and urologists. We report a case and the surgical technique of successful sling in the treatment of post-prostatectomy urinary incontinence. Sling surgery was performed on a 69-year-old male patient with severe urinary incontinence (6 pads/day) following radical prostatectomy. The procedure was conducted through the transobturator approach using a sling with a silicone foam pad to protect the urethra. At the 7-month follow-up the patient is using only 1 pad/day. We consider this operation an alternative to artificial urinary sphincter in cases of male sphincter incontinence.     

Bulbourethral composite suspension for treatment of male-acquired urinary incontinence

OBJECTIVES: We evaluated the efficacy of bulbourethral composite sling procedure in the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, or prostatic enucleation for benign prostatic hyperplasia, and posterior urethroplasty. METHODS: Between May 2000 and April 2005, a bulbourethral composite sling was performed in 26 patients with acquired urinary incontinence. Eight (30.8%) of these patients had severe urinary incontinence, and 18 (69.2%) had mild to moderate urinary incontinence. A polyester patch plus tension-free vaginal tape (TVT) device was used in the procedure. Prolene threads were attached to the two ends of polyester taper then passed from the perineal incision to a suprapubic incision with a TVT needle. The ends of the sutures and TVT were tied over the rectus fascia in the midline after repeated urethral pressure measurements reached 80-90 cm H2O. RESULTS: The follow-up period was 8-54 mo (mean: 28.3). The primary procedure failed in one patient. Of the remaining 25 patients, 1 patient died of cerebral hemorrhage 2 yr postoperatively, and 2 patients had recurrent stress incontinence in 1.5 and 2 yr postsurgery, respectively. The recurrent incontinence was severe in one patient and mild (one to two pads per day) in the other. The remaining 22 patients maintained urination and continence. The total success rate (cure and improved) was 92% (23 of 25). CONCLUSIONS: Bulbourethral composite sling procedure is a minimally invasive, safe, effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Temporary perineal discomfort or pain is a common complication of the procedure.     

Post-prostatectomy continence in the parkinsonian patient: the significance of poor voluntary sphincter control

A retrospective urodynamic study of 50 parkinsonian patients was done to determine the incidence and causes of post-prostatectomy incontinence. At presentation 22 per cent of the patients were incontinent. In 36 patients who underwent transurethral prostatectomy the incontinence rate was 17 per cent preoperatively and 28 per cent postoperatively. There was a clear association between normal voluntary sphincter control and urinary continence. After transurethral prostatectomy 5 of 6 patients continent preoperatively (83 per cent) who had abnormal sphincter control became incontinent compared to 1 of 24 (4.2 per cent) who had normal sphincter control. We conclude that the major risk of incontinence following prostatectomy in the parkinsonian patient is associated with lack of voluntary sphincter control.     

FIXED AND DYNAMIC URETHRAL COMPRESSION FOR THE TREATMENT OF POST-PROSTATECTOMY URINARY INCONTINENCE: IS HISTORY REPEATING ITSELF?

PURPOSE: We reviewed the evolution of appliances and devices used for treating post-prostatectomy urinary incontinence. MATERIALS AND METHODS: We used the MEDLINE to search the literature from 1966 to March 2000 and then manually searched bibliographies to identify studies that our initial search may have missed. RESULTS: The evolution of treatment for post-prostatectomy urinary incontinence may be traced back to the 18th century. Two main schools of thoughts simultaneously evolved. The first fixed urethral compression devices were constructed to enable urethral obstruction by fixed resistance. This outlet resistance allows voiding after intra-abdominal and intravesical pressure is elevated but it is sufficient to prevent leakage between urinations. The other school of thought preferred creation of dynamic urethral compression in which outlet resistance is not fixed but may be decreased when voiding is desired or elevated between urinations. Therapeutic fixed and dynamic urethral compression interventions may be further divided into external or internal compressive devices or procedures. External fixed compression devices may be traced back to antiquity. A penile clamp, similar to the later Cunningham clamp, and a truss designed to compress the urethra by external perineal compression were presented in the Heister textbook of surgery, Institutiones Chirurgicae, as early as 1750. Dynamic compressive devices applied externally were developed much later, such as the first artificial urinary sphincter, described by Foley, in 1947 and the Vincent apparatus, described in 1960. The modern era of fixed urethral compression began in 1961 with Berry. Acrylic prostheses impregnated with bismuth to allow radiographic visualization were produced in various shapes and sizes, and used to compress the urethra against the urogenital diaphragm. In 1968 the University of California-Los Angeles group under the direction of Kaufman began to use cavernous crural crossover to compress the bulbous urethra (Kaufman I). Later 2 other modifications were described, including approximation of the crura in the midline using a polytetrafluoroethylene mesh tape (Kaufman II) and an implantable silicone gel prosthesis (Kaufman III). With the advent of the artificial urinary sphincter pioneered by Scott in 1973 interest in passive urethral compression disappeared in favor of the implantation of an inflatable circumferential prosthetic sphincter. Recently there has been a trend back to passive urethral compression. Synthetic bolsters have been described that passively compress the bulbar urethra to achieve urinary incontinence after radical prostatectomy. CONCLUSIONS: Much creativity has been dedicated to solve the complex and challenging problem of post-prostatectomy urinary incontinence. Devices used for treating this condition may be grouped according to the mechanism of action and how they are applied. Passive urethral compression, long abandoned in favor of dynamic implantable sphincters, has reemerged. Further research in this field may determine which school of thought may provide the best solution for treating post-prostatectomy urinary incontinence.     

男性获得性尿失禁的治疗进展

男性获得性尿失禁是根治性前列腺切除术后或复杂性后尿道成形术后常见的并发症,轻度尿失禁可采用盆底肌肉锻炼、生物反馈疗法和药物治疗,中度或严重的尿失禁需采用如注射治疗、人工尿道括约肌植入、球部尿道悬吊术等积极的治疗方法。现对男性获得性尿失禁的治疗进展作一综述。