Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
BJU Int. 2010 Sep;106(5):681-6. doi: 10.1111/j.1464-410X.2009.09189.x.
To investigate and compare changes in the bladder function after radical prostatectomy (RP) and to correlate changes in subjective voiding symptoms with the observed changes in function.
In 72 patients who had RP between 2003 and 2004, we serially evaluated urodynamic studies (UDS) before RP and at 3, 6 and 36 months afterward. The short-form International Continence Society-male symptom questionnaire was also repeated at corresponding periods. Changes in bladder contraction and storage function after RP were compared for changes in subjective symptoms.
On serial UDS, there were reductions in maximum cystometric capacity, maximum detrusor pressure and maximum urethral closure pressure (MUCP) at 3 months, after which all remained relatively unchanged. On the questionnaire, the voiding symptom domain score improved (8.04 to 4.82, P < 0.001) while the storage domain score significantly and progressively worsened, beginning from 3 months (2.25 to 3.78, P= 0.04), resulting in an unchanged overall urinary symptom-related quality of life at 3 years. The incidence of detrusor overactivity increased from 37.5% before RP, to 45.8% at 3 months and 51.4% at 3 years. At 3 years, a recurring postvoid residual urine volume was the cause of the deterioration in the voiding symptom domain score, while a prominent reduction in MUCP resulted in a deterioration in the storage symptom score.
There is a reduction in bladder capacity, detrusor and sphincteric activity immediately after RP, stabilizing thereafter but remaining significantly reduced at 3 years. Although voiding symptoms improved in most men, the significant deterioration in storage symptoms, which might be attributed to sphincteric incompetence in addition to increased detrusor overactivity, became a source of overall urinary bother in the long term.
研究并比较根治性前列腺切除术（RP）后膀胱功能的变化，并将主观排尿症状的变化与观察到的功能变化相关联。
在 2003 年至 2004 年间接受 RP 的 72 例患者中，我们连续评估了术前、术后 3、6 和 36 个月的尿动力学研究（UDS）。还在相应的时期重复了简短的国际尿控协会男性症状问卷。将 RP 后膀胱收缩和储存功能的变化与主观症状的变化进行比较。
在连续的 UDS 中，最大膀胱容量、最大逼尿肌压力和最大尿道闭合压力（MUCP）在术后 3 个月时降低，此后均保持相对稳定。在问卷中，排尿症状域评分改善（8.04 降至 4.82，P < 0.001），而储存症状域评分显著且逐渐恶化，从术后 3 个月开始（2.25 升至 3.78，P=0.04），导致 3 年后整体与尿相关的生活质量保持不变。逼尿肌过度活动的发生率从术前的 37.5%增加到术后 3 个月的 45.8%和 3 年后的 51.4%。3 年后，残余尿量的增加是导致排尿症状域评分恶化的原因，而 MUCP 的显著降低导致储存症状评分恶化。
RP 后膀胱容量、逼尿肌和括约肌活动减少，此后稳定，但 3 年后仍明显减少。尽管大多数男性的排尿症状得到改善，但储存症状的显著恶化，除了逼尿肌过度活动外，可能归因于括约肌功能不全，这成为长期整体尿困扰的来源。
