经闭孔尿道球部悬吊术治疗男性压力性尿失禁的安全性与有效性  

Efficacy and safety of obturator urethraall suspension for the treatment of male stress urinary incontinence

作　　者：苏东煜 王起[1] 张晓鹏[1] 许克新[1] Su Dongyu;Wang Qi;Zhang Xiaopeng;Xu Kexin(Department of Urology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《中华泌尿外科杂志》2024年第9期676-680,共5页Chinese Journal of Urology

摘　　要：目的评估经闭孔尿道球部悬吊术治疗男性压力性尿失禁的安全性及有效性。方法回顾性分析2011年6月至2024年7月于北京大学人民医院行经闭孔尿道球部悬吊术治疗的13例男性压力性尿失禁患者的临床资料。患者年龄(71.6±5.4)岁。其中根治性前列腺切除术后9例,经尿道前列腺电切术后4例。13例中7例为中度尿失禁,6例为重度尿失禁。13例术前每日使用尿垫数量中位值为5(3,8)片,尿失禁生活质量问卷(1-Q0L)评分为16(12,28)分,男性压力性尿失禁分级(MSIGS)评分为2(2,3)分。13例均行经闭孔尿道球部悬吊术,患者取截石位,于阴囊下方解剖分离尿道球部。将吊带在引导针牵引下经闭孔拉出,吊带置于尿道球部,收紧吊带并调整吊带张力充分悬吊尿道。术后留置尿管1~7d。随访记录患者术后每日尿垫使用数量、I-QOL评分、MSICS评分及术后并发症情况。结果术后随访2~139个月,中位随访时间12个月。13例患者中2例治愈,9例尿失禁症状得到改善,2例症状无明显改善。患者术后每日使用尿垫数量中位值为1(1,4)片;I-QOL评分为75(4682)分,MSIGS评分为1(0,2)分,均较术前明显改善(P<0.01)。6例重度压力性尿失禁患者末次随访,每日使用尿垫数量较术前明显减少[2(1,5)片与8(78)片],I-Q0L评分明显升高[60(35,70)分与12(10,16)分]、MSICS评分明显降低[2(1,3)分与3(24)分],差异均有统计学意义(P<0.01)。7例中度压力性尿失禁患者末次随访,每日使用尿垫数量较术前明显减少[1(0,1)片与4(4,5)片],I-Q0L评分明显升高[80(75,82)分与21(18,30)分]、MSIGS评分明显降低[0(0,1)分与2(2,3)分],差异均有统计学意义(P<0.01)。1例重度压力性尿失禁患者在术后第3年出现尿潴留,经膀胱造瘘术后好转,该患者末次随访时MSICS评分为3分,1-Q0L评分为23分(术前为9分),每日尿垫使用数量为6片(术前为10片),仍为重度压力性尿失禁,较术前症状无明显变化。1例重度Objective To evaluate the safety and efficacy of transtobturator urethral sling operation in the treatment of male stress urinary incontinence.Methods A retrospective analysis was conducted on the clinical data of 13 male patients with stress urinary incontinence who underwent transvaginal sling procedure at Peking University Peoples Hospital from June 2011 to July 2024.The patients'average age was(71.6±5.4)years.Among them,9 patients had undergone radical prostatectomy,and 4 had undergone transurethral resection of the prostate(TURP).Of the 13 patients,7 had moderate urinary incontinence,and 6 had severe urinary incontinence.The median daily number of urine pads used by the 13 patients before surgery was 5(3,8),and the median score of the Incontinence Quality of Life Questionnaire(I-QOL)was 16(12,28).The median score of the Male Stress Urinary Incontinence Grading Scale(MSIGS)was 2(2,3).All the 13 patients underwent transvaginal sling procedure.The patients were placed in the lithotomy position,and the urethral bulb was dissected anatomically beneath the scrotum.The sling was guided by a needle and pulled out through the obturator foramen,and placed over the urethral bulb.The sling was tightened and the tension adjusted to fully suspend the urethra.A urinary catheter was left in place for 1-7 days after surgery.The patients'postoperative daily use of urine pads,scores of the I-QOL and MSIGS,and postoperative complications were followed up.Results Postoperative follow-up ranged from 2 to 139 months,with a median follow-up time of 12 months.Of the 13 patients,2 were cured,9 had improved and 2 had no significant improvement.The number of diapers used per day by patients postoperatively was 1(1,4)pieces,the I-QOL score was 75(46,82),and the MSIGS score was 1(0,2),which were all significantly improved compared to preoperative values(P<0.01).Among the 6 severe stress urinary incontinence patients who were followed up,the number of diapers used per day was significantly reduced compared to preoperative values[2(1,5)vs

关 键 词：压力性尿失禁 男性 经闭孔尿道球部悬吊术 疗效 安全性 

分 类 号：R699.5[医药卫生—泌尿科学]