Natsume Osamu, Kondo Hideaki, Cho Masaki, Fujimoto Kiyohide, Ozono Seiichiro, Hirao Yoshihiko
Department of Urology, Nara Prefectural Rehabilitation Center.
Hinyokika Kiyo. 2004 Jan;50(1):1-6.
Prostate cancer is common in aged men and radical prostatectomy is established as a therapeutic measure. However, to date there is little information about its impact on voiding function. We conducted a prospective clinical study to elucidate the impact of radical prostatectomy on voiding function in 17 patients with prostate cancer, by urological evaluation including filling and voiding cystometry (pressure flow study). The patients who were estimated as having weak detrusor function including very weak detrusor function at 3 months postoperatively had significantly more frequent urinary incontinence compared with the others (p < 0.05). Of 8 patients who showed urinary incontinence for more than 3 months, 7 (88%) patients developed weak detrusor function at 3 months after operation, but 4 of them were estimated as having normal detrusor function preoperatively. These patients revealed reduced maximum flow rate and significantly increased quality of life score compared with the other patients (p < 0.05). An initially reduced bladder compliance disclosed a tendency to a rapid return to normal with time after surgery. Detrusor overactivity itself and neoadjuvant antiandrogen therapy were not related to prolonged postoperative urinary incontinence. The present study indicates that caution is required when administering medication that could potentially affect detrusor function, regardless of the type of preoperative detrusor function, in patients with persistent urinary incontinence or a reduced urinary stream. Particular emphasis is laid on the importance of urodynamic assessment of post-prostatectomy detrusor function and appropriate management modalities based on the results.
前列腺癌在老年男性中很常见，根治性前列腺切除术已成为一种治疗手段。然而，迄今为止，关于其对排尿功能影响的信息很少。我们进行了一项前瞻性临床研究，通过包括充盈和排尿膀胱测压（压力流率研究）在内的泌尿外科评估，来阐明根治性前列腺切除术对17例前列腺癌患者排尿功能的影响。术后3个月时被评估为逼尿肌功能较弱（包括非常弱的逼尿肌功能）的患者，与其他患者相比，尿失禁的频率明显更高（p<0.05）。在8例尿失禁持续超过3个月的患者中，7例（88%）在术后3个月出现逼尿肌功能减弱，但其中4例术前被评估为逼尿肌功能正常。与其他患者相比，这些患者的最大尿流率降低，生活质量评分显著升高（p<0.05）。最初膀胱顺应性降低显示出术后随时间推移有迅速恢复正常的趋势。逼尿肌过度活动本身和新辅助抗雄激素治疗与术后长期尿失禁无关。本研究表明，对于持续尿失禁或尿流减少的患者，无论术前逼尿肌功能类型如何，在使用可能影响逼尿肌功能的药物时都需要谨慎。特别强调了前列腺切除术后逼尿肌功能的尿动力学评估以及基于结果的适当管理模式的重要性。
