Constantinou C E, Freiha F S
Department of Urology, Stanford University Medical Center, California 94305-5118.
J Urol. 1992 Oct;148(4):1215-9; discussion 1219-20. doi: 10.1016/s0022-5347(17)36864-7.
A prospective study was done to evaluate the long-term effects of radical prostatectomy on the function of the bladder in filling and voiding. Preoperative urodynamic studies were done on 29 patients with a mean age of 62.9 +/- 5.2 years. The preoperative results show that 16 of the 29 patients demonstrated detrusor instability with maximum contractile pressures of 59 +/- 28 cm. water. Followup urodynamic assessment was done in 13 of these patients 22.9 +/- 1.1 months after surgery. Postoperatively, the maximum detrusor instability pressure did not decrease significantly (49 +/- 17 cm. water). Comparison of the operative and postoperative urodynamic characteristics of bladder filling shows that radical prostatectomy produced no significant change in the filling characteristics of the bladder in terms of bladder capacity, or volume at which sensations of fullness or urgency are reported. Voiding pressure-flow studies show a significant increase in maximum flow rate (8 +/- 1 to 13 +/- 2 ml., per second, p = 0.007), and significant decreases in maximum detrusor pressure (61 +/- 5.4 to 39 +/- 4 cm. water, p = 0.002), urethral opening pressure (45 +/- 7 to 25 +/- 4 cm. water, p = 0.004) and residual volume (150 +/- 37 to 62 +/- 43 ml., p = 0.019). Urethral profile measurements show that there was no significant change in either the maximum urethral closure pressure (94 +/- 9 to 83 +/- 9 cm. water) or external sphincter length (3.6 +/- 0.8 to 3.2 +/- 0.8 cm.). Preoperatively, the bladder neck pressures were 25 +/- 4.4 cm. water and were abolished after prostatectomy, indicating that the decrease in obstructive characteristics is due to removal of the prostate.
一项前瞻性研究旨在评估根治性前列腺切除术对膀胱充盈和排尿功能的长期影响。对29例平均年龄为62.9±5.2岁的患者进行了术前尿动力学研究。术前结果显示，29例患者中有16例表现为逼尿肌不稳定，最大收缩压为59±28厘米水柱。其中13例患者在术后22.9±1.1个月进行了随访尿动力学评估。术后，最大逼尿肌不稳定压力没有显著下降（49±17厘米水柱）。膀胱充盈的手术前后尿动力学特征比较显示，根治性前列腺切除术在膀胱容量或报告有饱腹感或尿急感时的体积方面，对膀胱的充盈特征没有产生显著变化。排尿压力-流量研究显示最大尿流率显著增加（从每秒8±1毫升增至13±2毫升，p = 0.007），最大逼尿肌压力、尿道开口压力和残余尿量显著下降（最大逼尿肌压力从61±5.4厘米水柱降至39±4厘米水柱，p = 0.002；尿道开口压力从45±7厘米水柱降至25±4厘米水柱，p = 0.004；残余尿量从150±37毫升降至62±43毫升，p = 0.019）。尿道轮廓测量显示最大尿道闭合压力（从94±9厘米水柱降至83±9厘米水柱）或外括约肌长度（从3.6±0.8厘米降至3.2±0.8厘米）均无显著变化。术前膀胱颈压力为25±4.4厘米水柱，前列腺切除术后消失，表明梗阻特征的降低是由于前列腺的切除。
