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目的探讨InVance球部悬吊术治疗男性尿失禁的安全性及有效性。方法2003年3月～2008年1月,应用InVance球部悬吊术治疗5例前列腺手术后尿失禁(经尿道前列腺电切术后4例,前列腺癌根治术后1例)。年龄62～76岁,平均67岁。尿失禁病程2～6年,平均4年。保守治疗无效。术前尿动力学检查平均漏尿点压力25.5cmH2O(20～32.5cmH2O)。截石位,会阴正中皮肤纵行切开3～5cm,显露尿道球部浅面球海绵体肌及双侧耻骨下支。采用InVance器械,电钻将带有1号不吸收合成线的钛螺钉分别在两侧的耻骨联合与耻骨下支连接部和其下约2cm处打钉6个。将聚丙烯筛网材料吊带裁剪成约3cm×4cm,将一侧耻骨下支上的三条合成线穿过吊网两角分别结扎固定,术中增加腹压后(下腹部加压等)咳嗽试验调节吊带的松紧度,或将逆行尿道漏尿点压调整为60cmH2O,留置导尿管。结果手术时间50～85min,平均60min。出血20～50ml,平均30ml。5天拔除气囊导尿管,均能自行排尿。5例随访6～24个月,平均12.6月,4例经尿道前列腺电切术后者尿失禁治愈,1例前列腺癌根治术后者尿失禁改善;尿动力学检查平均漏尿点压力65cmH2O(55～70cmHO)。结论InVance球部悬吊术是一种可治疗前列腺术后轻中度尿失禁的方法。
Objective To investigate the safety and efficacy of InVance ball suspension in the treatment of male urinary incontinence. Methods From March 2003 to January 2008, 5 cases of urinary incontinence after prostatectomy were treated with InVance ball suspension (4 cases after transurethral resection of the prostate and 1 case after radical prostatectomy). Age 62 to 76 years, mean 67 years. Urinary incontinence course of 2 to 6 years, an average of 4 years. Conservative treatment is invalid. Preoperative urodynamic examination average leakage point pressure 25.5cmH2O (20 ~ 32.5cmH2O). Lithotomy position, perineal midline skin longitudinal incision 3 ~ 5cm, revealing the urethral bulb shallow cavernous muscle and bilateral pubis. Using InVance instrument, the drill will be with No. 1 non-absorption of synthetic titanium screws on both sides of the pubic symphysis and the pubic branch under the connection and its next about 2cm Department nailing 6. The polypropylene mesh material sling cut into about 3cm × 4cm, the lower part of the pubic symphysis on the three lines through the two corners of the hanging net were ligation, surgery to increase abdominal pressure (lower abdominal pressure, etc.) cough test Adjust the tightness of the sling, or urethral retrograde urethral pressure adjusted to 60cmH2O indwelling catheter. Results The operation time was 50-85 minutes with an average of 60 minutes. Bleeding 20 ~ 50ml, an average of 30ml. 5 days removal of balloon catheter, can urinate on their own. Five cases were followed up for 6-24 months with an average of 12.6 months. Four cases of urinary incontinence were cured after transurethral resection of the prostate and one case of urinary incontinence after radical prostatectomy. The average urinary bladder pressure was 65cmH2O 55 ~ 70cmHO). Conclusion InVance ball suspension is a method that can treat mild to moderate urinary incontinence after prostatectomy.