Krane R J
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Mol Urol. 2000 Fall;4(3):279-86;discussion 287.
The incidence of incontinence after radical prostatectomy has ranged from 0 to 57% depending on the series and the type of incontinence considered. When total incontinence (not minimal stress incontinence) is reported, the average incidence is no more than 5%. This figure will increase with age, and in most series, approximately 10% of patients around the age of 70 will have total incontinence postoperatively. Preservation of continence after radical prostatectomy depends largely on the preservation of the distal urethral smooth-muscle sphincteric mechanism, which begins at the pelvic floor and ends at the prostatourethral junction. Newer techniques that attempt to increase postoperative continence include not cutting the puboprostatic ligaments and attempting to preserve as much striated muscle as possible along the length of the remaining urethra. Patients who are incontinent for 6 months after the surgery with no evidence of improvement will probably not become continent on their own. Therefore, some type of therapy should be considered. The options are periurethral injection of a bulking agent, implantation of an artificial sphincter, and, most recently, a bulbourethral sling procedure.
根据不同的研究系列以及所考虑的尿失禁类型，根治性前列腺切除术后尿失禁的发生率在0%至57%之间。当报告的是完全性尿失禁（而非轻度压力性尿失禁）时，平均发生率不超过5%。这一数字会随着年龄增长而增加，在大多数研究系列中，70岁左右的患者中约有10%术后会出现完全性尿失禁。根治性前列腺切除术后控尿情况很大程度上取决于远端尿道平滑肌括约肌机制的保留，该机制始于盆底，止于前列腺尿道交界处。试图提高术后控尿能力的新技术包括不切断耻骨前列腺韧带，并尽可能保留剩余尿道长度上的横纹肌。术后6个月仍有尿失禁且无改善迹象的患者可能无法自行恢复控尿。因此，应考虑某种类型的治疗。治疗选择包括尿道周围注射填充剂、植入人工括约肌，以及最近出现的球尿道悬吊手术。
