Gracilis urethromyoplasty – an autologous urinary sphincter for neurologically impaired patients with stress incontinence
| Autor: | Robert D. Hong, Toyohiko Watanabe, Michael B. Chancellor, Julie Ann Crewalk, David A. Rivas, Ivan Bourgeois |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Stress incontinence medicine.medical_specialty Urinary Incontinence Stress Urology Urinary Bladder Electric Stimulation Therapy Urinary incontinence External sphincter muscle of female urethra Transplantation Autologous Urethra medicine Humans Gracilis muscle Muscle Skeletal Spinal Cord Injuries Urinary bladder Urinary continence business.industry Urethral sphincter General Medicine medicine.disease Muscle Denervation Surgery Urodynamics medicine.anatomical_structure Neurology Anesthesia Sphincter Female Neurology (clinical) medicine.symptom business |
| Zdroj: | Spinal Cord. 35:546-549 |
| ISSN: | 1476-5624 1362-4393 |
| DOI: | 10.1038/sj.sc.3100444 |
| Popis: | Bakken Research Center,Maastricht, The NetherlandsPurpose: To investigate the e•ect of a neurovascularly intact gracilis muscle urethral wrap, to beused to restore urinary continence as a transposed urinary sphincter graft, in patients withneurogenic lower urinary tract dysfunction. Methods: Five neurologically impaired men with adenervated and damaged urinary sphincter mechanisms were treated. The etiology ofsphincteric insu†ciency included sphincter denervation in three patients, external sphincter-otomy in one, and urethral trauma due to a chronic indwelling catheter in one. All patientsunderwent gracilis urethromyoplasty sphincter reconstruction. Two patients also underwentconcomitant ileocystoplasty and one patient ileocystostomy because of poor bladdercompliance and a bladder capacity of 5200 ml. Results: The gracilis urethromyoplastyfunctioned as a new autologous sphincter with follow-ups ranging from 6–35 months. Thesurgery was successful in four patients. Three of the four patients were managed withintermittent catheterization, and one managed by ileocystostomy. The fifth patient continued torequire an indwelling urethral catheter. Conclusion: Gracilis urethromyoplasty achievescompression of the urethra using a neurovascularly intact muscle graft. The functional urethralclosure, obtained from the gracilis muscle wrap, assures dryness, and permits intermittent self-catheterization. It also avoids the risks of infection, erosion, or malfunction associated with theartificical urinary sphincter. The potential exists for electrical stimulation of this muscle graft toallow volitional control of the neo-sphincter mechanism, and voluntary voiding.Keywords: urinary incontinence; tissue transplantation; muscles; electric stimulation;urodynamic; spinal cord injury |
| Databáze: | OpenAIRE |
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