Cox Ashley, Herschorn Sender
aDepartment of Urology, Dalhousie University, Victoria General Hospital, Halifax, Nova Scotia bDivision of Urology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Curr Opin Urol. 2014 Nov;24(6):578-85. doi: 10.1097/MOU.0000000000000116.
The 5-year and 15-year life expectancy following the treatment of localized prostate cancer is excellent. Patients may develop rare but devastating complications following the surgery for prostate cancer. The purpose of this review is to summarize the available literature to date surrounding the management of the incontinent patient with a concomitant bladder neck contracture (BNC), or sphincteric stricture, following radical prostatectomy.
The literature consists of several case series, but no clinical trials exist to provide an evidence-based approach to the incontinent patient with concomitant BNC. Fortunately, this is a relatively rare clinical scenario and most cases are successfully managed with urethral dilatation or endoscopic techniques. Multiple endoscopic techniques are available. In addition, some authors include injectable agents in their armamentarium for the treatment of BNC. Open reconstructive techniques or permanent urinary diversion may be necessary in rare cases. Both male slings and artificial urinary sphincter may be considered for the management of concomitant urinary incontinence. Some authors suggest it is safe to proceed with simultaneous artificial urinary sphincter implantation at the time of endoscopic management of the BNC.
Management of the incontinent patient with concomitant BNC represents a challenging situation for the urologist. Several techniques are available to stabilize the BNC before safely proceeding with surgery for urinary incontinence. For the rare, complex case that has failed endoscopic management, referral to a surgeon experienced in reconstructive techniques is warranted.
局限性前列腺癌治疗后的5年和15年预期寿命良好。前列腺癌手术后患者可能会出现罕见但严重的并发症。本综述的目的是总结目前围绕根治性前列腺切除术后伴有膀胱颈挛缩（BNC）或括约肌狭窄的尿失禁患者管理的文献。
文献中有几个病例系列，但尚无临床试验为伴有BNC的尿失禁患者提供循证治疗方法。幸运的是，这是一种相对罕见的临床情况，大多数病例通过尿道扩张或内镜技术成功处理。有多种内镜技术可供选择。此外，一些作者将注射剂纳入其治疗BNC的手段中。在罕见情况下可能需要开放重建技术或永久性尿流改道。对于伴有尿失禁的处理，男性吊带和人工尿道括约肌均可考虑。一些作者认为在对BNC进行内镜处理时同时植入人工尿道括约肌是安全的。
对于泌尿外科医生而言，处理伴有BNC的尿失禁患者是一种具有挑战性的情况。在安全进行尿失禁手术之前，有多种技术可用于稳定BNC。对于内镜处理失败的罕见复杂病例，有必要转诊给有重建技术经验的外科医生。
