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男性压力性尿失禁的手术治疗——从吊带术到人工括约肌

[Operative therapy for stress urinary incontinence in men--from sling to artificial sphincter].

作者信息

Nyarangi-Dix J, Huber J, Haferkamp A, Hohenfellner M

机构信息

University of Heidelberg, Dept. of Urology, Heidelberg, Deutschland.

出版信息

Aktuelle Urol. 2011 Sep;42(5):306-10. doi: 10.1055/s-0031-1271547. Epub 2011 Jul 18.

Abstract

Radical prostatectomy is the most common cause of male urinary incontinence. Up to 90% of the patients are incontinent in the early postoperative phase. This rate reduces to 3-23% approximately 12 months after prostatectomy. Male slings and the ProACT™-Ballon system are preferred minimal invasive therapeutic options for mild to moderate incontinence. Mid-term continence rates of 50-80% can be achieved with bone anchored and adjustable slings or the adjustable ProACT™-Ballon system. The results after radiation therapy are significantly poorer. Randomised controlled trials with longer follow-ups are necessary in order to evaluate the effectiveness of these options for continence therapy. Considering the high continence rates of 73-92% in long-term follow-ups, the artificial urinary sphincter (AUS) still remains the gold standard in the therapy for incontinence in men with normal dexterity and mental status. In cases where continence cannot be achieved by implantation of an AUS, a urinary diversion can be taken into consideration.

摘要

根治性前列腺切除术是男性尿失禁最常见的原因。高达90%的患者在术后早期出现尿失禁。前列腺切除术后约12个月,这一比例降至3% - 23%。男性吊带和ProACT™球囊系统是治疗轻至中度尿失禁的首选微创治疗方案。使用骨锚定和可调节吊带或可调节ProACT™球囊系统可实现50% - 80%的中期控尿率。放射治疗后的效果明显较差。为了评估这些控尿治疗方案的有效性,有必要进行更长随访期的随机对照试验。考虑到长期随访中73% - 92%的高控尿率,人工尿道括约肌(AUS)仍然是治疗灵活性和精神状态正常男性尿失禁的金标准。在无法通过植入AUS实现控尿的情况下,可以考虑尿流改道。

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