Silva Laercio A, Andriolo Régis B, Atallah Alvaro N, da Silva Edina Mk
Urology, Universidade Federal de Sao Paulo - UNIFESP, Rua Doutor Nicolau de Sousa Queiros, 629 ap.130B, Sao Paulo, Sao Paulo, Brazil, 04105002.
Cochrane Database Syst Rev. 2011 Apr 13(4):CD008306. doi: 10.1002/14651858.CD008306.pub2.
Incontinence after prostatectomy for benign or malignant disease is a well known and often a feared outcome. Although small degrees of incidental incontinence may go virtually unnoticed, larger degrees of incontinence can have a major impact on a man's quality of life.Conceptually, postprostatectomy incontinence may be caused by sphincter malfunction and/or bladder dysfunction. The majority of men with post-prostatectomy incontinence (60 to 100%) have stress urinary incontinence, which is the complaint of involuntary urinary leakage on effort or exertion, or on sneezing or coughing. This may be due to intrinsic sphincter deficiency and may be treated with surgery for optimal management of incontinence. Detrusor dysfunction is more common after surgery for benign prostatic disease.
To determine the effects of surgical treatment for urinary incontinence related to presumed sphincter deficiency after prostate surgery for either benign LUTS secondary to BPH (transurethral resection of prostate (TURP), photo vaporization of the prostate, laser enucleation of the prostate and open prostatectomy) or radical prostatectomy for prostate cancer (retropubic, perineal, laparoscopic, or robotic).
We searched the Cochrane Incontinence Group Specialised Register (searched 28 June 2010), MEDLINE (January 1966 to January 2010), EMBASE (January 1988 to January 2010), LILACS (January 1982 to January 2010) and the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies.
Randomised or quasi-randomised trials that include surgical treatments of urinary incontinence after prostate surgery.
Two authors independently screened the trials identified, appraised quality of papers and extracted data.
Only one study with 45 participants met the inclusion criteria. Men were divided in two subgroups (minimal or total incontinence) and each group was randomized to artificial urethral sphincter (AUS) implantation or Macroplastique injection. Follow-up ranged from six to 120 months. In the trial as a whole, the men treated with AUS were more likely to be dry (18/20, 82%) than those who had the injectable treatment (11/23, 46%) (OR 5.67, 95% CI 1.28 to 25.10). However, this effect was only statistically significant for the men with more severe ('total') incontinence (OR 8.89, 95% CI 1.40 to 56.57) and the confidence intervals were wide. There were more severe complications in the group undergoing AUS, and the costs were higher.
AUTHORS' CONCLUSIONS: The evidence available at present is limited because only one small randomised clinical trial was identified. Although the result is favourable for the implantation of AUS in the group with severe incontinence, this result should be considered with caution due to the small sample size and uncertain methodological quality of the study found.
良性或恶性疾病前列腺切除术后的尿失禁是一个众所周知且常令人担忧的结果。虽然轻度的偶然尿失禁可能几乎不被察觉，但较严重的尿失禁会对男性的生活质量产生重大影响。从概念上讲，前列腺切除术后尿失禁可能由括约肌功能障碍和/或膀胱功能障碍引起。大多数前列腺切除术后尿失禁的男性（60%至100%）存在压力性尿失禁，即用力、运动、打喷嚏或咳嗽时出现不自主漏尿的情况。这可能是由于内在括约肌缺陷所致，可通过手术进行最佳的尿失禁管理。逼尿肌功能障碍在良性前列腺疾病手术后更为常见。
确定针对良性前列腺增生（BPH）继发的良性下尿路症状（经尿道前列腺切除术（TURP）、前列腺光汽化术、前列腺激光剜除术和开放性前列腺切除术）或前列腺癌根治性前列腺切除术（耻骨后、会阴、腹腔镜或机器人辅助）后因推测的括约肌缺陷导致的尿失禁进行手术治疗的效果。
我们检索了Cochrane尿失禁小组专业注册库（2010年6月28日检索）、MEDLINE（1966年1月至2010年1月）、EMBASE（1988年1月至2010年1月）、LILACS（1982年1月至2010年1月）以及相关文章的参考文献列表，手工检索会议论文集并联系研究者以查找研究。
包括前列腺手术后尿失禁手术治疗的随机或半随机试验。
两位作者独立筛选所识别的试验、评估论文质量并提取数据。
仅有一项纳入45名参与者的研究符合纳入标准。男性被分为两个亚组（轻度或完全尿失禁），每组随机接受人工尿道括约肌（AUS）植入或Macroplastique注射。随访时间为6至120个月。在整个试验中，如果将两组视为一个整体，接受AUS治疗的男性比接受注射治疗的男性更有可能实现干爽（18/20，82%对比11/23，46%）（比值比5.67，95%置信区间1.28至25.10）。然而，这种效果仅在尿失禁更严重（“完全”）的男性中具有统计学意义（比值比8.89，95%置信区间1.40至56.57），且置信区间较宽。接受AUS治疗的组出现更严重的并发症，且成本更高。
目前可得的证据有限，因为仅识别出一项小型随机临床试验。尽管结果对严重尿失禁组植入AUS有利，但鉴于所发现研究的样本量小且方法学质量不确定，该结果应谨慎看待。
