锥状肌膀胱颈悬吊术治疗儿童尿失禁

目的 探讨评价运用锥状肌膀胱颈悬吊术治疗儿童膀胱出口阻力低下型尿失禁的临床疗效。 方法 分析2004~2018年因膀胱出口阻力低下型尿失禁行锥状肌膀胱颈悬吊术的29例患儿临床资料,于术前、术后分别行尿流动力学、排尿性膀胱尿道造影(VCUG)、国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-SF)评分等,采用配对样本t检验及Wilcoxon符号秩和检验评价手术前后各指标的差异。 结果 术后复查:(1)VCUG,膀胱颈均被抬高,并已纠正漏斗状开放状态;(2)功能性尿道长度增加1.04 cm(P<0.001)、最大尿道闭合压升高11.69 cmH₂O(P=0.001),最大尿道压术前、术后差异无统计学意义(P>0.05);(3)根据ICI-Q-SF评分,尿失禁症状明显改善(P<0.05),其中11例(37.93%)患儿通过配合清洁间歇导尿(CIC)、口服抗胆碱能药物等能达到完全控尿,余患儿均存在CIC不规范问题;(4)出现并发症患者共7例(24.14%),其中2例(6.90%)为本术式直接并发症。 结论 在配合术后CIC、口服药物等综合治疗的前提下,锥状肌膀胱颈悬吊术是治疗膀胱出口阻力低下型尿失禁的良好术式。

Bladder neck suspension with pyramidalis in the management of pediatric urinary incontinence

Objective To evaluate the clinical efficacy of bladder neck suspension with pyramidalis in the treatment of urinary incontinence in children with sphincteric incompetence. Methods Clinical data of 29 children with urinary incontinence who underwent bladder neck suspension with pyramidalis during 2004 and 2018 were retrospectively analyzed. All patients received urodynamic examinations and voiding cystourethrography(VCUG), and filled in ICI-Q-SF scale before and after operation. The differences in the indexes were analyzed with paired samples t test and Wilcoxon rank sum test. Results VCUG showed the bladder necks were raised in all patients and the funnel-shaped openings were corrected. The functional urethral length and maximum urethral closure pressure increased by 1.04 cm(P<0.001)and 11.69 cmH₂O(P=0.001), respectively, while the maximum urethral pressure had no improvement after surgery(P>0.05). The ICI-Q-SF score showed that incontinence was significantly improved(P<0.05), 11 patients(37.93%)gained good control with adjuvant clean intermittent catheterization(CIC)and oral anticholinergic drugs, and the other 18 patients showed CIC problems. Complications were observed in 7 patients(24.14%), and 2 patients(6.90%)complications were caused by bladder neck suspension. Conclusion Bladder neck suspension with pyramidalis is effective to treat children with sphincteric incompetence if standardized CIC and anticholinergic medication are provided.