Bugel H, Pfister C, Sibert L, Cappele O, Khalaf A, Grise P
Service d'Urologie, Hôpital Charles Nicolle, Rouen, France.
Prog Urol. 1999 Dec;9(6):1068-76.
To evaluate the results and the place of a minimally invasive intraurethral injection technique designed to improve the efficacy of the urethral sphincter in urinary incontinence after prostatic surgery.
A prospective study of 26 Macroplastique injections performed in 15 patients with a mean age of 66.4 years (range: 54 to 78 years) was conducted over an 18-month period. Eleven patients received 2 injections. Prostatic surgery consisted of retropubic radical prostatectomy (9 cases), transurethral resection (4 cases) or open prostatectomy (2 cases). Three patients received pelvic irradiation. Evaluation at 1, 3 and 12 months consisted of clinical questionnaire and urodynamic assessment.
Rapid deterioration of the initial improvement was observed (40% success at 1 month; 71% at 3 months; 33% at 6 months; 26% at 12 months). No significant influence was demonstrated for post-prostatectomy radiotherapy, the patient's age, more proximal bladder dysfunction, severity of incontinence or preoperative status. However, better results were observed when the resting urethral closure pressure remained higher than 30 cm H2O.
We believe that intraurethral injections still have a place in the therapeutic armamentarium for incontinence after prostatic surgery with satisfactory initial results, which unfortunately deteriorate after 3 months. Our study confirms the value of Macroplastique compared to other substances. It is difficult to define the predictive factors of failure, but a closure pressure greater than 30 cm H2O remains essential. Finally, an interval of at least 3 months should be observed before repeating this procedure in the case of an insufficient result.
评估一种旨在提高前列腺手术后尿失禁患者尿道括约肌功能的微创尿道内注射技术的效果及地位。
在18个月的时间里，对15例平均年龄66.4岁（范围：54至78岁）的患者进行了26次Macroplastique注射的前瞻性研究。11例患者接受了2次注射。前列腺手术包括耻骨后根治性前列腺切除术（9例）、经尿道切除术（4例）或开放性前列腺切除术（2例）。3例患者接受了盆腔放疗。在1、3和12个月时进行评估，包括临床问卷调查和尿动力学评估。
观察到初始改善迅速恶化（1个月时成功率为40%；3个月时为71%；6个月时为33%；12个月时为26%）。前列腺切除术后放疗、患者年龄、更接近膀胱的功能障碍、失禁严重程度或术前状态均未显示出显著影响。然而，当静息尿道闭合压保持高于30 cm H₂O时，观察到更好的结果。
我们认为尿道内注射在前列腺手术后尿失禁的治疗手段中仍占有一席之地，初始结果令人满意，但不幸的是3个月后效果会恶化。我们的研究证实了Macroplastique与其他物质相比的价值。难以确定失败的预测因素，但闭合压大于30 cm H₂O仍然至关重要。最后，如果结果不理想，在重复此操作之前应至少观察3个月的间隔时间。
