吊带完整性对恢复大鼠SUI模型漏尿点压作用的实验研究

目的：验证剪断尿道下的吊带未消除吊带抗尿失禁作用的假说,探讨尿道吊带的无张力原则.方法：用持续阴道扩张（VD）的方法预先在40只雌性wistar大鼠建立压力性尿失禁（SUI）模型.10只接受完整的尿道吊带手术;10只植入完整的尿道吊带后,把吊带的尿道下部分剪断一半;10只植入完整的尿道吊带后,把吊带的尿道下部分完全剪断;10只接受了伪吊带手术.术后6周,所有大鼠通过预先放置的耻骨上导管测定crede手法诱导的腹腔漏尿点压（ALPP）,并测定膀胱内压.Kruskal-Wallis H检验比较数据,P〈0.05为差异有统计学意义.结果：吊带完全切断组、吊带切断一半组和吊带完整组都可同样升高ALPP,且都显著高于伪手术组的值（分别为24.9、26.7、27.9vs20.7cmH2O,P〈0.0001）.4组排尿高峰压无显著的差别,表示吊带术的各组不存在膀胱出口梗阻（BOO）.吊带完全切断组、吊带切断一半组和吊带完整组的膀胱顺应性6周后同伪手术组相比显著降低（P=0.007、0.05、0.05）.结论：吊带尿道下部分的完整性并不是吊带治疗SUI大鼠模型所必需的.然而吊带手术可以降低膀胱的顺应性.这可以解释在临床中观察到的同吊带手术有关的排尿功能障碍.

Role of Sling Integrity in the Restoration of Leak Point Pressure in the Stress Urinary Incontinence Rat Model

Objective：We tested the hypothesis that cutting the sling at its suburethral section does not cancel its anti-incontinence effect,i, e. （id est） tested the principle of tension-free in vaginal sling. Methods： Stress urinary incontinence（SUI） was created in 40 female Wistar rats by the previously established method of continuous vaginal distension （VD）. 10 animals received a vaginal sling; 10 received a vaginal sling in which the suburethral portion of the sling was cut immediately after placement ; 10 received a vaginal sling in which the suburethral portion of the sling was cut half immediately after placement , and 10 received a sham vaginal sling. Six weeks after the procedures crede maneuver induced abdominal leak point pressure（ALPP）was determined and a cystometrogram （CMG） was done using anesthesia in each animal via a previously implanted suprapubic catheter. Kruskal-Wallis test were performed with a significance level of 0.05. Results：The cut ,cut half and intact slings increased ALPP similarly and these values were significantly higher than that of the sham sling （24.9,26.7 and 27.9 cmH2O, respectively, vs 20.7, P〈0. 0001）. Peak micturition pressure was not significantly different among the 4 groups, indicating absent bladder outlet obstruction（BOO） in the sling groups. Bladder compliance was significantly decreased 6 weeks after placement of a cut or cut half or intact sling compared with the sham sling （P=0. 007,0.05 and 0.05, respectively）. Conclusions：An intact suburethral portion is not a requirement for sling effectiveness in the rat model of SUI. However, the sling procedure decreases bladder compliance, This may explain the observed voiding dysfunction associated with sling procedures.