Groutz A, Blaivas J G, Chaikin D C, Weiss J P, Verhaaren M
Weill Medical College, Cornell University, New York, New York, USA.
J Urol. 2000 Jun;163(6):1767-70.
We examine various mechanisms of post-radical prostatectomy incontinence.
A total of 83 consecutive men (mean age 68 +/- 6.6 years) referred for evaluation of persistent post-radical prostatectomy incontinence were enrolled in the study. All patients underwent clinical and urodynamic evaluation. Final diagnosis was based on clinical judgment considering patient history, pad test, voiding diary, free (unintubated) uroflow measurements, video urodynamics and linear passive urethral resistance relation curves. We compared free uroflow and pressure flow obtained with a 7Fr urethral catheter in place, and empirically defined low urethral compliance as at least 10 ml. per second difference between these measurements.
Sphincteric incontinence was the most common urodynamic finding, occurring in 73 patients (88%). Detrusor instability was identified in 28 patients (33.7%) and in 6 (7.2%) was the main cause of incontinence. In 2 other patients bladder outlet obstruction (1.2%) or impaired detrusor contractility (1.2%) was the only urodynamic finding. Impaired detrusor contractility was diagnosed by linear passive urethral resistance relation in 82% of cases but considered to be clinically relevant in only a third. In 25 cases (30.1%) low urethral compliance was noted, which we consider nearly synonymous with urethral scarring.
Sphincteric incontinence is the most common urodynamic finding in patients with post-radical prostatectomy incontinence, although other findings may coexist. The most accurate diagnosis is attained when all objective measures are put in perspective with the clinical setting.
我们研究了根治性前列腺切除术后尿失禁的各种机制。
共有83例连续的男性患者（平均年龄68±6.6岁）因根治性前列腺切除术后持续性尿失禁前来评估并纳入本研究。所有患者均接受了临床和尿动力学评估。最终诊断基于临床判断，综合考虑患者病史、尿垫试验、排尿日记、自由（未插管）尿流率测量、影像尿动力学以及线性被动尿道阻力关系曲线。我们比较了留置7Fr尿道导管时获得的自由尿流率和压力流率，并根据经验将低尿道顺应性定义为这两种测量结果之间每秒至少相差10毫升。
括约肌性尿失禁是最常见的尿动力学表现，见于73例患者（88%）。28例患者（33.7%）存在逼尿肌不稳定，其中6例（7.2%）是尿失禁的主要原因。另外2例患者的唯一尿动力学表现为膀胱出口梗阻（1.2%）或逼尿肌收缩力受损（1.2%）。82%的病例通过线性被动尿道阻力关系诊断出逼尿肌收缩力受损，但只有三分之一被认为具有临床相关性。25例（30.1%）患者存在低尿道顺应性，我们认为这几乎等同于尿道瘢痕形成。
括约肌性尿失禁是根治性前列腺切除术后尿失禁患者最常见的尿动力学表现，尽管可能同时存在其他表现。当将所有客观测量结果与临床情况相结合时，可获得最准确的诊断。
