Orsola Anna, Morote Juan
Servicio de Urología, Hospital Vall d'Hebrón, 08035 Barcelona, España.
Arch Esp Urol. 2009 Dec;62(10):786-92. doi: 10.4321/s0004-06142009001000003.
To present recent data on the epidemiology of urinary incontinence in prostate cancer (PCa). To review the incidence of urinary incontinence, its impact on quality of life and related pharmacoeconomic features.
We performed a bibliographic review about the complications of the various therapeutic options for PCa including radical prostatectomy (RP) (open, laparoscopic and robotic), external beam radiotherapy, brachytherapy, cryotherapy, and high intensity focused ultrasound (HIFU).
The lack of uniformity for urinary incontinence definition, for its evaluation, and for the way to report it makes the interpretation of functional results and impact on quality of life after any treatment option difficult and uneven. Generally, we documented that urinary incontinence after treatment appears more often in patients undergoing radical surgery. Nevertheless, we stated that neurovascular bundle preservation, performance of the procedure in high volume centers, by high volume surgeons, and development of robotic surgery may positively influence the global outcomes of this technique. Moderate incontinence is less frequent after external beam radiotherapy, but the association of rectal pain and diarrhea, in up to 40%of the patients, worsens voiding symptoms. Irritative and obstructive voiding symptoms after perineal brachytherapy are especially associated with long term erectile dysfunction as well as rectal morbidity. In the case of cryotherapy and HIFU the available studies are case series and there are not randomized studies comparing them with the primary treatment of localized PCa.
Each treatment modality for PCa is associated with a different pattern of changes in the urinary, sexual, intestinal and hormonal related quality of life domains. Two key factors when evaluating incontinence are information about continence before the procedure and the use of validated, self-administered evaluation means. Although technical improvements in all procedures should contribute to diminish the impact of complications, we should not forget the trend to the association of therapies- multimodal therapy- has a higher complication profile. Therefore, they should be reserved for patients in whom a benefit has been proved.
呈现前列腺癌（PCa）尿失禁流行病学的最新数据。综述尿失禁的发生率、其对生活质量的影响以及相关药物经济学特征。
我们对PCa各种治疗方案的并发症进行了文献综述，这些治疗方案包括根治性前列腺切除术（RP）（开放、腹腔镜和机器人辅助）、外照射放疗、近距离放疗、冷冻疗法和高强度聚焦超声（HIFU）。
尿失禁的定义、评估方法及报告方式缺乏一致性，这使得对任何治疗方案后的功能结果及其对生活质量的影响进行解读变得困难且不一致。总体而言，我们记录到治疗后尿失禁在接受根治性手术的患者中更常见。然而，我们指出保留神经血管束、在大型中心由经验丰富的外科医生进行手术以及机器人手术的发展可能会对该技术的整体结果产生积极影响。外照射放疗后中度尿失禁较少见，但高达40%的患者会出现直肠疼痛和腹泻，这会加重排尿症状。会阴近距离放疗后的刺激性和梗阻性排尿症状尤其与长期勃起功能障碍以及直肠发病率相关。对于冷冻疗法和HIFU，现有研究均为病例系列，尚无将它们与局限性PCa的主要治疗方法进行比较的随机研究。
PCa的每种治疗方式在泌尿、性、肠道和激素相关生活质量领域都有不同的变化模式。评估尿失禁时的两个关键因素是术前的控尿信息以及使用经过验证的自我管理评估方法。尽管所有手术的技术改进都应有助于减少并发症的影响，但我们不应忘记治疗联合——多模式治疗——有更高并发症发生率的趋势。因此，它们应仅用于已证明有获益的患者。
