Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Urol. 2011 Jun;185(6):2254-9. doi: 10.1016/j.juro.2011.02.021. Epub 2011 Apr 17.
We assessed the impact of preoperative overactive bladder on the continence results of artificial urinary sphincter implantation, and describe the rates and risk factors associated with the development of de novo and persistent overactive bladder after artificial urinary sphincter surgery.
A total of 129 consecutive patients treated with radical prostatectomy who had preoperative videourodynamics and virgin artificial urinary sphincter implantation were included in the study. During preoperative and postoperative visits patients were specifically queried about overactive bladder symptoms, anticholinergic medication use and continence status.
The presence of concomitant overactive bladder symptoms before artificial urinary sphincter surgery did not negatively impact the overall continence results of the artificial urinary sphincter. De novo overactive bladder developed after artificial urinary sphincter surgery in up to a fourth (23%) of patients with pure stress incontinence (no overactive bladder). Most patients (71%) with preoperative mixed stress urinary incontinence plus overactive bladder symptoms continued to have persistent overactive bladder after artificial urinary sphincter surgery despite marked improvement of incontinence. Patients with a low preoperative cystometric capacity of 200 ml or less were more likely to have overactive bladder after artificial urinary sphincter surgery. Other clinical and urodynamic factors (eg the presence of detrusor overactivity) were not predictive. No risk factors predicted the development of de novo overactive bladder after artificial urinary sphincter surgery.
The presence of preoperative overactive bladder does not adversely impact the overall continence results of the artificial urinary sphincter. Patients with mixed stress urinary incontinence plus overactive bladder symptoms preoperatively should not be denied the male incontinence surgery (artificial urinary sphincter) unless the overactive bladder symptoms are intractable. De novo and persistent overactive bladder occurs commonly after artificial urinary sphincter surgery. Thorough preoperative counseling is imperative to align patient expectations.
我们评估了术前膀胱过度活动症对人工尿道括约肌植入术后控尿效果的影响，并描述了人工尿道括约肌手术后新发和持续性膀胱过度活动症的发生率和相关风险因素。
共纳入 129 例行根治性前列腺切除术且术前行尿动力学检查和初次人工尿道括约肌植入术的连续患者。在术前和术后访视中，专门询问患者膀胱过度活动症症状、抗胆碱能药物使用和控尿状态。
术前存在膀胱过度活动症症状并不会对人工尿道括约肌的整体控尿效果产生负面影响。在单纯压力性尿失禁（无膀胱过度活动症）患者中，有四分之一（23%）的患者在人工尿道括约肌手术后新发膀胱过度活动症。尽管失禁明显改善，但术前混合性压力性尿失禁加膀胱过度活动症症状的大多数患者（71%）仍持续存在膀胱过度活动症。术前膀胱容量为 200ml 或更少的患者在人工尿道括约肌手术后更有可能出现膀胱过度活动症。其他临床和尿动力学因素（如逼尿肌过度活动的存在）不能预测。无任何危险因素可预测人工尿道括约肌手术后新发膀胱过度活动症的发生。
术前膀胱过度活动症的存在并不会对人工尿道括约肌的整体控尿效果产生不利影响。术前存在混合性压力性尿失禁加膀胱过度活动症症状的患者，如果膀胱过度活动症症状无法控制，不应被拒绝接受男性尿失禁手术（人工尿道括约肌）。人工尿道括约肌手术后常发生新发和持续性膀胱过度活动症。在术前进行彻底的咨询对于调整患者的预期非常重要。
