选择性括约肌切断术治疗脊髓损伤性膀胱尿道功能障碍

行经尿道选择性括约肌切断术２０例，采用膀胱尿道造影尿流动力学同步检查，定位诊断和选择切断。术前间歇导尿控制尿路感染，术后辅以正确手法排尿。２０例术后随访１２～２５个月。剩余尿量降至３０ｍｌ以下，尿路感染控制，中段尿培养阳性率降至１７．６％；ＢＵＮ正常；１１例肾盂输尿管扩张，积水改善；７例有膀胱输尿管返流者中，４例基本恢复，３例明显减轻；最大尿道闭合压平均下降６．３１ｋＰａ；功能性尿道长度平均缩短１．８９ｃｍ；１１例尿失禁得到控制，６例无明显变化，３例加重。

Selected transurethral sphincterotomy for the management of bladder and sphincter dysfunction in patient with spinal cord injury

cases of patients suffering from spinal cord injury with bladder and sphincter dysfunction were treated by selected sphincterotomy under the synchronous monitoring of urodynamics and cystourethrography. Preoperatively, intermittent catheterization were performed to control urinary tract infection, Crede maneuver or abdominal straining has been practiced after the operation to help voiding. Post-operative follow up study lasted 12 to 25 months. The amount of residual urine decreased to less than 30 ml; routine urine culture remained positive in only 17. 6 per cent and BUN were normal in all cases. Dilatation of renal pelvis and ureters were relieved in 11 cases. The maximum urethral close pressure decreased by 6. 31 kPa and the length of functional urethral decreased by1.89cm.11 of them achieved an acceptable micturition without incontinence.There has been no improvement of micturation in 6 and became even worse in another 3.