Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
J Urol. 2011 Oct;186(4):1370-5. doi: 10.1016/j.juro.2011.05.089.
Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings.
A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test.
No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume.
Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.
男性吊带已成为治疗前列腺切除术后压力性尿失禁男性患者的一种流行且有效的治疗方法。传统上，由于担心患者在排尿过程中无法克服吊带的固定阻力，因此在逼尿肌收缩力受损或valsalva 排尿的男性中谨慎使用或避免使用吊带。我们提出，对于逼尿肌收缩力受损和/或在尿动力学检查时通过腹部用力排尿的前列腺切除术后尿失禁男性，可以安全地使用吊带进行治疗。
在一家医疗机构对 2004 年 1 月至 2010 年 1 月期间接受初始吊带手术的前列腺切除术后尿失禁患者进行了回顾性研究。检查了术前尿动力学特征以及术后患者整体改善印象、残余尿量和无创尿流数据。根据逼尿肌收缩力差或valsalva 排尿情况对患者进行分组。排除标准为缺乏术前尿动力学和/或术后残余尿量。共分析了 92 例患者。使用学生 t 检验和卡方检验比较变量。
比较逼尿肌收缩力或valsalva 排尿时，术后残余尿量（术后 4 个月时的平均值）或尿潴留无统计学差异。在有术后尿流数据的患者亚组中，术后最大流量或排空量无差异。
对于逼尿肌收缩力受损或valsalva 排尿的前列腺切除术后尿失禁患者，如果术前排空正常，则可以安全地进行吊带手术治疗。
