妇科泌尿学(5)
人工尿道括约肌用于尿道疤痕及弛缓而不适用于常规手术的病人。括约肌阻压尿道，病人排尿时，内泵系统排空括约肌，解除梗阻而排尿。
预后
手术被认为是张力性尿失禁的标准治疗方法。对经严格选择的病人进行成功的手术可达75%-85%的纠正率。若在用药后有所改善的病人或标准手术成功的可能性不大时，进行手术的改良，会达到更高的成功率。
一次手术失败增加了再次手术失败及术后并发症发生的可能性。术者一定要屏弃可以先做简单易行的手术，待失败或复发时再行复杂手术的观点。应在首次手术时即选择可达最优效果的术式。
参考文献
1.Aronson MP, Bates SM, Jacoby AF et al. Periurethral and paravaginal anatomy : an endovaginal magmetic resonance imaging study. Am J Obstet Gynecol, 1995;173:1702
2.Bent AE, Mclennan MT. Surgical management of urinary incontinence. Obstet Gynecol Clin North Am,1998;25:883
3.Bergman A, Ballard CA, Koonings PP. Comparison of three different surgical procedures for genuine stress incontinence: Prospective randomized study. Am J Obstet Gynecol, 1989;160:1102
4.Bergman A, Elia G. Three surgical procedures for GSI:five year follow-up of a prospective randimized study. Am J Obstet ynecol, 1995; 173:66
5.BO K,Talseth T. Long-term effect of pelvic floor musce exercise 5 years after cessation of organized training. Obstet Gynecol,1996;261:265
6.Fitzpatrick CC, Elkins MJ, Delancey JL. The surgical anatomy of needle bladder neck suspension. Obstet Gynecol, 1996;87:44
7.Fourcroy JL. Urogynecology update: incontinence. Hosp Pract, 1998;15:63
8.Khullar V. Pelvic floor stimulation in the treatment of mixed incontinence complicated by low-pressure urethra.. Br J Obstet Gynecol,1997;104:96
9.Mouristen L， Annlise R。 Bladder neck mobility evaluated by beginal ultrasomography。 Br J Obstet Gynecol。1993；71；166
10.Strohbehn K,Quint LE, Prince MR et al. Magnetic resonance imaging anatomy of the female urethra: a direct distological comparison. Obstet Gynecol,1996;88:750
11.Yalcin OT, Hassa H, Ozalp S et al. Results of the anti-incontinence operations and Kegel exercises in patients with type II anatomic stress incontinence. Acta Obstet Gynecol Scand,1998;77:341
12.朱兰，郎景和,刘珠凤,等.张力性尿失禁不同术式的比较.中华医学杂志.1998,78:601
13.朱兰.妇科泌尿学.中华妇产科学.见曹泽毅主编>.第一版.北京:人民卫生出版社,1999,1354
14.苑雅茹,朱楣光.应力性尿失禁的诊断和治疗.国外医学妇产科分册.1999;26:233, 百拇医药
预后
手术被认为是张力性尿失禁的标准治疗方法。对经严格选择的病人进行成功的手术可达75%-85%的纠正率。若在用药后有所改善的病人或标准手术成功的可能性不大时，进行手术的改良，会达到更高的成功率。
一次手术失败增加了再次手术失败及术后并发症发生的可能性。术者一定要屏弃可以先做简单易行的手术，待失败或复发时再行复杂手术的观点。应在首次手术时即选择可达最优效果的术式。
参考文献
1.Aronson MP, Bates SM, Jacoby AF et al. Periurethral and paravaginal anatomy : an endovaginal magmetic resonance imaging study. Am J Obstet Gynecol, 1995;173:1702
2.Bent AE, Mclennan MT. Surgical management of urinary incontinence. Obstet Gynecol Clin North Am,1998;25:883
3.Bergman A, Ballard CA, Koonings PP. Comparison of three different surgical procedures for genuine stress incontinence: Prospective randomized study. Am J Obstet Gynecol, 1989;160:1102
4.Bergman A, Elia G. Three surgical procedures for GSI:five year follow-up of a prospective randimized study. Am J Obstet ynecol, 1995; 173:66
5.BO K,Talseth T. Long-term effect of pelvic floor musce exercise 5 years after cessation of organized training. Obstet Gynecol,1996;261:265
6.Fitzpatrick CC, Elkins MJ, Delancey JL. The surgical anatomy of needle bladder neck suspension. Obstet Gynecol, 1996;87:44
7.Fourcroy JL. Urogynecology update: incontinence. Hosp Pract, 1998;15:63
8.Khullar V. Pelvic floor stimulation in the treatment of mixed incontinence complicated by low-pressure urethra.. Br J Obstet Gynecol,1997;104:96
9.Mouristen L， Annlise R。 Bladder neck mobility evaluated by beginal ultrasomography。 Br J Obstet Gynecol。1993；71；166
10.Strohbehn K,Quint LE, Prince MR et al. Magnetic resonance imaging anatomy of the female urethra: a direct distological comparison. Obstet Gynecol,1996;88:750
11.Yalcin OT, Hassa H, Ozalp S et al. Results of the anti-incontinence operations and Kegel exercises in patients with type II anatomic stress incontinence. Acta Obstet Gynecol Scand,1998;77:341
12.朱兰，郎景和,刘珠凤,等.张力性尿失禁不同术式的比较.中华医学杂志.1998,78:601
13.朱兰.妇科泌尿学.中华妇产科学.见曹泽毅主编>.第一版.北京:人民卫生出版社,1999,1354
14.苑雅茹,朱楣光.应力性尿失禁的诊断和治疗.国外医学妇产科分册.1999;26:233, 百拇医药