Thiel David D, Young Paul R, Broderick Gregory A, Heckman Michael G, Wehle Michael J, Igel Todd C, Petrou Steven P
Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
Urology. 2007 Feb;69(2):315-9. doi: 10.1016/j.urology.2006.10.026.
To determine whether urodynamic or clinical parameters can predict artificial urinary sphincter (AUS) outcome in patients who were incontinent after radical prostatectomy (RP). Incontinence after RP is secondary to intrinsic sphincter deficiency, but urodynamics have been advocated before AUS placement to detect factors that could limit surgical success.
We reviewed all AUSs placed for RP incontinence from January 1995 to December 2004. The preoperative clinical parameters and urodynamic parameters were correlated with surgical success using linear and logistic regression analysis, respectively. Surgical failure was defined as requiring more than one pad per day.
The data from 86 patients (mean age 72 years) were analyzed. Of these 86 patients, 15 (17%) were wearing more than 1 pad per day at the last follow-up visit; 11 patients (13%) considered their operation a failure; and 20 patients (24%) had postoperative urgency. The presence of detrusor overactivity (P = 0.92), low first sensation (P = 0.52), low bladder compliance (P = 0.38), and bladder capacity less than 300 mL (P = 0.58) in patients did not predict for AUS failure compared with patients without these findings. No clinical parameters were found that demonstrated a statistical association with the number of pads per day. Older patients considered themselves less improved (P = 0.012) than did younger patients.
No evidence has shown that patients who are incontinent after RP who have detrusor overactivity, a low first sensation, decreased compliance, or a low bladder capacity have worse post-AUS outcomes than other patients. Older patients tended to have decreased perceived improvement. We found no clinical or urodynamic parameter that would be a contraindication to AUS placement for post-RP incontinence.
确定尿动力学参数或临床参数能否预测根治性前列腺切除术（RP）后尿失禁患者人工尿道括约肌（AUS）的治疗效果。RP后尿失禁继发于固有括约肌功能不全，但在植入AUS之前一直提倡进行尿动力学检查，以发现可能限制手术成功的因素。
我们回顾了1995年1月至2004年12月期间因RP后尿失禁而植入的所有AUS。术前临床参数和尿动力学参数分别通过线性回归分析和逻辑回归分析与手术成功率相关联。手术失败定义为每天需要使用超过一片尿垫。
分析了86例患者（平均年龄72岁）的数据。在这86例患者中，15例（17%）在最后一次随访时每天使用超过1片尿垫；11例患者（13%）认为手术失败；20例患者（24%）术后出现尿急。与没有这些表现的患者相比，存在逼尿肌过度活动（P = 0.92）、初始感觉低（P = 0.52）、膀胱顺应性低（P = 0.38）以及膀胱容量小于300 mL（P = 0.58）的患者并不能预测AUS失败。未发现与每天尿垫使用数量有统计学关联的临床参数。老年患者认为自身改善程度低于年轻患者（P = 0.012）。
没有证据表明，RP后尿失禁且伴有逼尿肌过度活动、初始感觉低、顺应性降低或膀胱容量低的患者，其AUS术后效果比其他患者更差。老年患者的自我感觉改善程度往往较低。我们未发现任何临床或尿动力学参数可作为RP后尿失禁患者植入AUS的禁忌证。
