Madjar S, Raz S, Gousse A E
Departments of Urology, University of Miami, Florida, USA.
J Urol. 2001 Aug;166(2):411-5.
We reviewed the evolution of appliances and devices used for treating post-prostatectomy urinary incontinence.
We used the MEDLINE to search the literature from 1966 to March 2000 and then manually searched bibliographies to identify studies that our initial search may have missed.
The evolution of treatment for post-prostatectomy urinary incontinence may be traced back to the 18th century. Two main schools of thoughts simultaneously evolved. The first fixed urethral compression devices were constructed to enable urethral obstruction by fixed resistance. This outlet resistance allows voiding after intra-abdominal and intravesical pressure is elevated but it is sufficient to prevent leakage between urinations. The other school of thought preferred creation of dynamic urethral compression in which outlet resistance is not fixed but may be decreased when voiding is desired or elevated between urinations. Therapeutic fixed and dynamic urethral compression interventions may be further divided into external or internal compressive devices or procedures. External fixed compression devices may be traced back to antiquity. A penile clamp, similar to the later Cunningham clamp, and a truss designed to compress the urethra by external perineal compression were presented in the Heister textbook of surgery, Institutiones Chirurgicae, as early as 1750. Dynamic compressive devices applied externally were developed much later, such as the first artificial urinary sphincter, described by Foley, in 1947 and the Vincent apparatus, described in 1960. The modern era of fixed urethral compression began in 1961 with Berry. Acrylic prostheses impregnated with bismuth to allow radiographic visualization were produced in various shapes and sizes, and used to compress the urethra against the urogenital diaphragm. In 1968 the University of California-Los Angeles group under the direction of Kaufman began to use cavernous crural crossover to compress the bulbous urethra (Kaufman I). Later 2 other modifications were described, including approximation of the crura in the midline using a polytetrafluoroethylene mesh tape (Kaufman II) and an implantable silicone gel prosthesis (Kaufman III). With the advent of the artificial urinary sphincter pioneered by Scott in 1973 interest in passive urethral compression disappeared in favor of the implantation of an inflatable circumferential prosthetic sphincter. Recently there has been a trend back to passive urethral compression. Synthetic bolsters have been described that passively compress the bulbar urethra to achieve urinary incontinence after radical prostatectomy.
Much creativity has been dedicated to solve the complex and challenging problem of post-prostatectomy urinary incontinence. Devices used for treating this condition may be grouped according to the mechanism of action and how they are applied. Passive urethral compression, long abandoned in favor of dynamic implantable sphincters, has reemerged. Further research in this field may determine which school of thought may provide the best solution for treating post-prostatectomy urinary incontinence.
我们回顾了前列腺切除术后尿失禁治疗器具和装置的发展历程。
我们利用MEDLINE检索了1966年至2000年3月的文献，然后手动检索参考文献，以识别我们初步检索可能遗漏的研究。
前列腺切除术后尿失禁的治疗发展可追溯到18世纪。同时出现了两种主要的思想流派。第一种是固定尿道压迫装置，通过固定阻力实现尿道阻塞。这种出口阻力可使腹内压和膀胱内压升高后排尿，但足以防止排尿间隙漏尿。另一种思想流派倾向于创建动态尿道压迫，其中出口阻力不是固定的，而是在需要排尿时降低，或在排尿间隙升高。治疗性固定和动态尿道压迫干预措施可进一步分为外部或内部压迫装置或手术。外部固定压迫装置可追溯到古代。早在1750年，海斯特的《外科学原理》（Institutiones Chirurgicae）一书中就介绍了一种类似于后来的坎宁安夹的阴茎夹，以及一种通过外部会阴压迫来压迫尿道的疝带。外部应用的动态压迫装置的开发要晚得多，比如1947年福勒描述的第一个人工尿道括约肌，以及1960年描述的文森特装置。固定尿道压迫的现代时代始于1961年贝里的研究。浸渍铋以实现放射影像学可视化的丙烯酸假体有各种形状和尺寸，用于将尿道压向泌尿生殖膈。1968年，在考夫曼的指导下，加利福尼亚大学洛杉矶分校的团队开始使用海绵体脚交叉来压迫球部尿道（考夫曼I型）。后来又描述了另外两种改进方法，包括使用聚四氟乙烯网带在中线处逼近海绵体脚（考夫曼II型）和一种可植入硅胶凝胶假体（考夫曼III型）。随着1973年斯科特开创的人工尿道括约肌的出现，对被动尿道压迫的兴趣消失了，转而青睐植入可充气的环形假体括约肌。最近又出现了回归被动尿道压迫的趋势。有人描述了合成支撑物，可被动压迫球部尿道以治疗前列腺切除术后尿失禁。
人们为解决前列腺切除术后尿失禁这一复杂且具有挑战性的问题投入了大量创造力。用于治疗这种疾病的装置可根据作用机制和应用方式进行分类。长期以来被动态可植入括约肌取代的被动尿道压迫又重新出现了。该领域的进一步研究可能会确定哪种思想流派能为治疗前列腺切除术后尿失禁提供最佳解决方案。
