Hennessey Derek B, Hoag Nathan, Gani Johan
Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada.
Transl Androl Urol. 2017 Jul;6(Suppl 2):S103-S111. doi: 10.21037/tau.2017.04.14.
Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.
膀胱功能障碍是根治性前列腺切除术后（RP）较为常见的尿动力学表现。它可能是前列腺切除术后尿失禁（PPI）的唯一原因，也可能与压力性尿失禁（SUI）同时存在。本综述旨在全面回顾RP术后膀胱功能障碍的诊断及不同治疗方法。我们使用医学搜索引擎进行了全面的文献综述。检索词包括以下组合：PPI、逼尿肌过度活动（DO）、逼尿肌活动低下（DU）、顺应性受损、抗胆碱能药物、A型肉毒毒素（肉毒素）和骶神经调节（SNM）。从相关医学文献中提取了定义、概述及管理方案。DO、DU和顺应性受损很常见，可能单独出现或与SUI合并出现。在一些患者中，这些情况在RP术前就已存在，而在另一些患者中则是由于去神经支配和手术改变所致。DO可用抗胆碱能药物、肉毒素和SNM治疗。DO可能需要在SUI手术前进行治疗。DU可能是男性吊带手术的禁忌证，因为一些患者可能会出现尿潴留。严重的膀胱顺应性受损可能是SUI手术的禁忌证，因为上尿路可能会有风险。每种个体功能障碍都可能影响PPI治疗的结果，临床医生应警惕对PPI患者膀胱功能障碍的管理。
