PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with neurogenic urinary incontinence due to an incompetent outlet may be offered bladder neck reconstruction, but the quest for the perfect surgical-outlet procedure continues. Our aim was to characterize continence and complications after modified Mitchell urethral lengthening/bladder neck reconstruction (MMBNR) with sling and to introduce a modification of exposure that facilitates subsequent steps of MMBNR.
UNASSIGNED: A single-institution, retrospective cohort study of patients who underwent primary MMBNR between May 2011 and July 2019 was performed. Data on demographics, urodynamic testing, operative details, unanticipated events, continence, bladder changes, and additional procedures were collected. A 2013 modification that permits identification of the incompetent bladder neck prior to urethral unroofing was applied to the last 17 patients. The trigone and bladder neck are exposed via an oblique low anterolateral incision on the bladder. Ureteral reimplantation is not routinely performed. Focal incision of the endopelvic fascia after posterior plate creation limits breadth of blunt dissection for sling placement. Descriptive statistics were utilized.
UNASSIGNED: A total of 25 patients (13 females) had MMBNR with sling at a median age of 10 years [interquartile range (IQR) 8-11]. Bladder augmentation was performed concurrently in 14/25 (56%) patients. At a median of 5.0 (IQR 3.9-7.5) years follow-up after MMBNR, 9/11 (82%) without bladder augmentation and 13/14 (93%) with bladder augmentation had no leakage per urethra during the day without further continence procedures. Of the three patients with persistent incontinence, two achieved continence with bladder wall Botox injection (overall continence 24/25, 96%). New and recurrent vesicoureteral reflux was noted in five patients and one patient, respectively. Two patients required subsequent bladder augmentation for pressures and one other will likely require it. None have required bladder neck closure or revision.
UNASSIGNED: MMBNR with sling provides promising continence per urethra in neurogenic bladder with low need for secondary continence procedures. Ongoing modifications may achieve elusive total continence.
UNASSIGNED: A single-institution, retrospective cohort study of patients who underwent primary MMBNR between May 2011 and July 2019 was performed. Data on demographics, urodynamic testing, operative details, unanticipated events, continence, bladder changes, and additional procedures were collected. A 2013 modification that permits identification of the incompetent bladder neck prior to urethral unroofing was applied to the last 17 patients. The trigone and bladder neck are exposed via an oblique low anterolateral incision on the bladder. Ureteral reimplantation is not routinely performed. Focal incision of the endopelvic fascia after posterior plate creation limits breadth of blunt dissection for sling placement. Descriptive statistics were utilized.
UNASSIGNED: A total of 25 patients (13 females) had MMBNR with sling at a median age of 10 years [interquartile range (IQR) 8-11]. Bladder augmentation was performed concurrently in 14/25 (56%) patients. At a median of 5.0 (IQR 3.9-7.5) years follow-up after MMBNR, 9/11 (82%) without bladder augmentation and 13/14 (93%) with bladder augmentation had no leakage per urethra during the day without further continence procedures. Of the three patients with persistent incontinence, two achieved continence with bladder wall Botox injection (overall continence 24/25, 96%). New and recurrent vesicoureteral reflux was noted in five patients and one patient, respectively. Two patients required subsequent bladder augmentation for pressures and one other will likely require it. None have required bladder neck closure or revision.
UNASSIGNED: MMBNR with sling provides promising continence per urethra in neurogenic bladder with low need for secondary continence procedures. Ongoing modifications may achieve elusive total continence.
摘要：
未经批准：由于出口不称职而导致神经源性尿失禁的患者可以进行膀胱颈重建术，但寻求完美的外科手术仍在继续。我们的目的是表征使用吊带改良的Mitchell尿道延长/膀胱颈重建术（MMBNR）后的尿失禁和并发症，并引入一种改良的暴露方式，以促进MMBNR的后续步骤。
未经评估：单一机构，对2011年5月至2019年7月接受原发性MMBNR的患者进行了回顾性队列研究.人口统计数据，尿动力学测试，操作细节,意想不到的事件,尿失禁,膀胱改变,并收集了其他程序。2013年对最后17名患者进行了修改，该修改允许在尿道去顶之前识别无能的膀胱颈。三角区和膀胱颈通过膀胱上的倾斜前外侧切口暴露。不常规进行输尿管再植入。后板形成后，内肾盂筋膜的局部切口限制了钝性解剖的宽度，以放置吊带。利用描述性统计数据。
UNASSIGNED：共有25例患者（13例女性）患有带吊索的MMBNR，中位年龄为10岁[四分位距（IQR）8-11]。14/25（56％）的患者同时进行膀胱扩张。在MMBNR后的中位数为5.0（IQR3.9-7.5）年的随访中，没有膀胱扩张的9/11（82％）和膀胱扩张的13/14（93％）在白天没有尿道渗漏，没有进一步的节制手术。在三名持续性尿失禁患者中，两个人通过膀胱壁注射Botox实现了节制（总体节制24/25，96％）。在5例患者和1例患者中发现了新的和复发性的膀胱输尿管反流，分别。两名患者需要随后的膀胱增大压力，另一名患者可能需要。没有人需要膀胱颈闭合或翻修。
UNASSIGNED：带吊带的MMBNR在神经源性膀胱中提供了每个尿道的有希望的失禁，对二次失禁程序的需求较低。正在进行的修改可以实现难以捉摸的完全节制。
未经评估：单一机构，对2011年5月至2019年7月接受原发性MMBNR的患者进行了回顾性队列研究.人口统计数据，尿动力学测试，操作细节,意想不到的事件,尿失禁,膀胱改变,并收集了其他程序。2013年对最后17名患者进行了修改，该修改允许在尿道去顶之前识别无能的膀胱颈。三角区和膀胱颈通过膀胱上的倾斜前外侧切口暴露。不常规进行输尿管再植入。后板形成后，内肾盂筋膜的局部切口限制了钝性解剖的宽度，以放置吊带。利用描述性统计数据。
UNASSIGNED：共有25例患者（13例女性）患有带吊索的MMBNR，中位年龄为10岁[四分位距（IQR）8-11]。14/25（56％）的患者同时进行膀胱扩张。在MMBNR后的中位数为5.0（IQR3.9-7.5）年的随访中，没有膀胱扩张的9/11（82％）和膀胱扩张的13/14（93％）在白天没有尿道渗漏，没有进一步的节制手术。在三名持续性尿失禁患者中，两个人通过膀胱壁注射Botox实现了节制（总体节制24/25，96％）。在5例患者和1例患者中发现了新的和复发性的膀胱输尿管反流，分别。两名患者需要随后的膀胱增大压力，另一名患者可能需要。没有人需要膀胱颈闭合或翻修。
UNASSIGNED：带吊带的MMBNR在神经源性膀胱中提供了每个尿道的有希望的失禁，对二次失禁程序的需求较低。正在进行的修改可以实现难以捉摸的完全节制。
