Smither Anna R, Guralnick Michael L, Davis Nancy B, See William A
Louisiana Urology, LLC, Baton Rouge, LA, USA.
BMC Urol. 2007 Feb 5;7:2. doi: 10.1186/1471-2490-7-2.
Urinary incontinence (UI) following radical prostatectomy is a well-recognized risk of the surgery. In most patients post-operative UI improves over time. To date, there is limited objective, quantitative data on the natural history of the resolution of post-prostatectomy UI. The purpose of this study was to define the natural history of post radical prostatectomy incontinence using an objective quantitative tool, the 1-hour standard pad test.
203 consecutive patients underwent radical prostatectomy by a single surgeon between 03/98 & 08/03. A standardized 1-hour pad test was administered at subsequent postoperative clinic visits. The gram weight of urine loss was recorded and subdivided into four groups defined according to the grams of urine loss: minimal (<1 g), mild (>1, <10 g), moderate (10-50 g) and severe (>50 g). Patients were evaluated: at 2 weeks (catheter removal), 6 weeks, 18 weeks, 30 weeks, 42 weeks and 54 weeks. The data set was analyzed for average urine loss as well as grams of urine loss at each time point, the percentage of patients and the distribution of patients in each category.
Mean follow up was 118 weeks. The majority of patients experienced incontinence immediately after catheter removal at 2 weeks that gradually improved with time. While continued improvement was noted to 1 year, most patients who achieved continence did so by 18 weeks post-op.
While the majority of patients experience mild to severe UI immediately following catheter removal, there is a rapid decrease in leaked weight during the first 18 weeks following RRP. Patients continue to improve out to 1 year with greater than 90% having minimal leakage by International Continence Society criteria.
根治性前列腺切除术后尿失禁（UI）是该手术公认的风险。在大多数患者中，术后尿失禁会随着时间改善。迄今为止，关于前列腺切除术后尿失禁缓解自然史的客观定量数据有限。本研究的目的是使用客观定量工具——1小时标准尿垫试验来确定根治性前列腺切除术后尿失禁的自然史。
1998年3月至2003年8月期间，由同一位外科医生连续为203例患者实施根治性前列腺切除术。在随后的术后门诊就诊时进行标准化的1小时尿垫试验。记录尿失禁的克数，并根据尿失禁克数分为四组：极少（<1克）、轻度（>1，<10克）、中度（10 - 50克）和重度（>50克）。在术后2周（拔除导尿管时）、6周、18周、30周、42周和54周对患者进行评估。分析数据集的平均尿失禁量以及每个时间点的尿失禁克数、患者百分比和各分类患者的分布情况。
平均随访时间为118周。大多数患者在术后2周拔除导尿管后立即出现尿失禁，随着时间推移逐渐改善。虽然在术后1年仍有持续改善，但大多数实现控尿的患者在术后18周时即已实现。
虽然大多数患者在拔除导尿管后立即经历轻度至重度尿失禁，但在根治性前列腺切除术后的前18周内，漏尿量迅速减少。患者持续改善直至1年，按照国际尿失禁学会标准，超过90%的患者漏尿极少。
