Kielb Stephanie J, Clemens J Quentin
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Urology. 2005 Aug;66(2):392-6. doi: 10.1016/j.urology.2005.03.026.
To assess the filling, storage, and voiding urodynamic parameters in a large group of men with urinary incontinence after radical prostatectomy.
We reviewed the videourodynamics testing results for 146 consecutive men referred for urinary incontinence after radical prostatectomy.
The mean patient age was 69.0 years (range 48 to 85), and the mean interval since radical prostatectomy was 4 years (range 4 months to 19 years). All but four tests were performed more than 12 months postoperatively. Stress urinary incontinence (SUI) was demonstrated in 139 men (95%), with a mean abdominal leak point pressure of 59 cm H2O. A statistically significant correlation was found between the leak point pressure and static urethral pressure profilometry measurements (r = 0.46, P < 0.0001). The mean urethral pressure profilometry measurements in those with SUI were significantly lower than in those without (46.6 versus 69 cm H2O, P = 0.001). A total of 34 patients had diminished compliance or detrusor instability, but this was the sole finding in only 3. A hypocontractile detrusor response was seen in 49 patients, and 35 of these augmented voiding by abdominal straining. Patients with previous radiotherapy (n = 24) were more likely to have bladder outlet obstruction; the other parameters were similar to those in patients without radiotherapy.
Incontinence after radical prostatectomy is caused by intrinsic sphincter deficiency in the vast majority of patients. Urethral pressure profilometry measurements correlated with the severity of SUI, as measured by abdominal leak point pressure. Bladder outlet obstruction may coexist with SUI in a significant portion of patients. During voiding, a hypocontractile detrusor response may be seen, but the clinical significance of this finding is unclear.
评估一大组前列腺癌根治术后尿失禁男性患者的充盈、储尿和排尿尿动力学参数。
我们回顾了146例因前列腺癌根治术后尿失禁前来就诊的连续男性患者的视频尿动力学检测结果。
患者平均年龄为69.0岁（范围48至85岁），自前列腺癌根治术后的平均间隔时间为4年（范围4个月至19年）。除4例检查外，所有检查均在术后12个月以上进行。139例男性（95%）表现为压力性尿失禁（SUI），平均腹压漏尿点压力为59 cm H2O。漏尿点压力与静态尿道压力测定值之间存在统计学显著相关性（r = 0.46，P < 0.0001）。SUI患者的平均尿道压力测定值显著低于无SUI患者（46.6对69 cm H2O，P = 0.001）。共有34例患者顺应性降低或逼尿肌不稳定，但仅3例患者以此为唯一表现。49例患者出现逼尿肌收缩功能减退，其中35例通过腹部用力增加排尿。既往接受过放疗的患者（n = 24）更易出现膀胱出口梗阻；其他参数与未接受放疗的患者相似。
绝大多数前列腺癌根治术后尿失禁患者是由内在括约肌缺陷引起的。尿道压力测定值与通过腹压漏尿点压力衡量的SUI严重程度相关。膀胱出口梗阻可能在相当一部分患者中与SUI并存。排尿时可能会出现逼尿肌收缩功能减退，但这一发现的临床意义尚不清楚。
