Pastore Antonio L, Palleschi Giovanni, Illiano Ester, Zucchi Alessandro, Carbone Antonio, Costantini Elisabetta
Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Rome, Italy -
Uroresearch Association, Latina, Italy -
Minerva Urol Nefrol. 2017 Jun;69(3):234-241. doi: 10.23736/S0393-2249.16.02790-9. Epub 2016 Nov 3.
The purpose of this review was to assess the evidence provided by literature regarding the role of detrusor overactivity (DO) in determining urinary incontinence in patients submitted to radical prostatectomy.
The research was based on the online PubMed database spanning the period from November 1997 to May 2016. The review was conducted in accordance with the systematic review guidelines provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of twenty-three articles met the eligibility criteria for this systematic review. The eligible studies included a total of 812 patients with a mean number of 36 patients per study (range 29-264). The rate of patients with urodynamic DO after radical prostatectomy and reporting urge urinary incontinence ranged from 3 to 63%. The postradical prostatectomy DO was more likely to occur in patients who already had it preoperatively [OR =2.30, 95% CI: 1.39-3.82; studies 9; participants 419]. However, most representative studies accordingly indicate that intrinsic sphincter deficiency is the most common cause of postprostatectomy incontinence (PPI), considered as the sole responsible factor for such patients' incontinence (88-100% of patients evaluated); the same studies report that isolated bladder dysfunction is uncommon and that it occurs in only 3% of patients.
The review results suggest that DO could be considered as another possible underlying mechanism for PPI. Although sphincter incompetence and weakness are the most common mechanisms related to incontinence after prostatectomy, DO may coexist or be an isolated cause of PPI. Therefore, urodynamic studies are essential to show which is and/or are the exact cause(s) of incontinence in each individual patient after RP.
本综述的目的是评估文献中关于逼尿肌过度活动（DO）在接受根治性前列腺切除术患者尿失禁发生中所起作用的证据。
本研究基于1997年11月至2016年5月期间的在线PubMed数据库。该综述按照Cochrane协作网提供的系统评价指南以及系统评价和Meta分析的首选报告项目（PRISMA）进行。
共有23篇文章符合本系统评价的纳入标准。符合条件的研究共纳入812例患者，每项研究平均36例患者（范围29 - 264例）。根治性前列腺切除术后出现尿动力学DO且报告有急迫性尿失禁的患者比例为3%至63%。根治性前列腺切除术后DO更易发生于术前就存在DO的患者[比值比（OR）=2.30，95%置信区间（CI）：1.39 - 3.82；9项研究；419名参与者]。然而，大多数具有代表性的研究表明，固有括约肌缺陷是前列腺切除术后尿失禁（PPI）最常见的原因，被认为是此类患者尿失禁的唯一责任因素（在接受评估的患者中占88% - 100%）；同样这些研究报告称，单纯膀胱功能障碍并不常见，仅发生于3%的患者中。
综述结果表明，DO可被视为PPI的另一种可能潜在机制。尽管括约肌功能不全和薄弱是前列腺切除术后与尿失禁相关的最常见机制，但DO可能并存或为PPI的孤立病因。因此，尿动力学研究对于明确每个接受根治性前列腺切除术患者尿失禁的确切原因至关重要。
