Soave A, Dahlem R, Rink M, Ahyai S, Fisch M
Urologische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Urologe A. 2012 Apr;51(4):494-9. doi: 10.1007/s00120-012-2814-9.
Orthotopic urinary diversion (OUD) is performed in almost half of all radical cystectomies. This review presents an overview of the incidence, pathophysiology, and management of urinary incontinence (UI) after OUD. Daytime and nighttime UI are reported in up to 15% and 45% of cases after OUD, respectively. UI after OUD is more frequent in women. Stress incontinence is the most common reason for daytime urinary leakage, while an absent vesicourethral reflex with reduced external sphincter muscle tone is associated with nighttime UI. Conservative management has limited therapeutic value in UI after OUD. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT® system in mild stress UI. Implantation of the artificial urinary sphincter system AMS 800® is the standard treatment for stress UI after OUD. Very limited data exist regarding results after implantation of newer artificial urinary sphincter systems such as the FlowSecure® and the Zephyr® ZSI 375 after OUD.
几乎一半的根治性膀胱切除术都采用原位尿流改道术（OUD）。本综述概述了OUD术后尿失禁（UI）的发生率、病理生理学及管理。据报道，OUD术后白天和夜间尿失禁的发生率分别高达15%和45%。OUD术后尿失禁在女性中更为常见。压力性尿失禁是白天漏尿的最常见原因，而膀胱尿道反射消失伴外括约肌肌张力降低与夜间尿失禁有关。保守治疗对OUD术后尿失禁的治疗价值有限。手术方法包括可调节和不可调节吊带以及用于轻度压力性尿失禁的ProACT®系统。植入人工尿道括约肌系统AMS 800®是OUD术后压力性尿失禁的标准治疗方法。关于OUD术后植入新型人工尿道括约肌系统（如FlowSecure®和Zephyr® ZSI 375）后的结果，现有数据非常有限。
