尿失禁に対するYoung-Dees-Leadbetter手術の経験

Abstract

Urinary incontinence caused by functional or anatomical incompetence of the urethral sphincter is one of the most challenging problems in urological surgery. Posterior urethral lengthening accomplished by tubularization of the trigonum, which was proposed by H. H. Young, J. E. Dees and G. W. Leadbetter, has been shown to improve the outcome in epispadia patients with incontinence. We report our experiences of Young-Dees-Leadbetter's operation in three patients. Case 1 was a 55-year-old woman who had undergone removal of the external genitalia to treat genital Paget's disease, resulting in total incontinence. About one half of the urethra had been removed, resulting in a shortened urethral length of 2.5 cm. Case 2 was a 6-year-old boy with penile epispadia, who had leadage of about a third of the total urine volume. Case 3, an 18 year-old female patient, suffered from total urinary incontinence which had resulted from a defect in the entire urethra and bladder neck following a motor vehicle accident. Posterior urethral lengthening together with ureteral reimplantation was performed on these three patients according to Leadbetter's or Dees' method. Subtotal continence was achieved in cases 1 and 3, and incontinence was completely cured in case 2. Based on our results with these three cases, we feel that Young-Dees-Leadbetter's operation is a useful method for treating sphincteric incontinence, particularly in female patients with an anatomical urethral defect.