Goonewardene S S, Gillatt D, Persad R
Southend University Hospital, East of England Deanery, Southend-on-Sea, UK.
McQuarrie University, Sydney, Australia.
J Robot Surg. 2018 Sep;12(3):397-400. doi: 10.1007/s11701-018-0803-8. Epub 2018 Mar 21.
Male Stress Urinary Incontinence is a complication post robotic radical prostatectomy. This is a major problem that needs to be solved, since it has great impact on quality of life affecting the patient's physical activity and social well-being. A systematic review relating to literature on impact of preoperative PFE on continence outcomes for patients undergoing prostatectomy was conducted. The search strategy aimed to identify all references related to pelvic floor exercises and post-prostatectomy. Search terms used were as follows: (Pelvic floor exercises) AND (incontinence) AND (prostatectomy). The following databases were screened from 2000 to September 2017: CINAHL, MEDLINE (NHS Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, Web of Science. In addition, searches using Medical Subject Headings (MeSH) and keywords were conducted using Cochrane databases. Two UK-based experts in prostate cancer and robotic surgery were consulted to identify any additional studies. In the 6 months following surgery, the continence rates, as defined by the use of one pad or less per day, were 94% (44 of 47) and 96% (48 of 50) in the PFE and biofeedback groups and control groups (PFE alone), respectively (P = 0.596) (Bales et al. in Urology 56: 627-630, 2000). This demonstrates preoperative PFE may improve early continence after RP. Geraerts et al. (Eur Urol 64:766-772, 2013) demonstrated the "incontinence impact" was in favour of a group with PFE at 3 and 6 months after surgery. This demonstrates again the advantage of preoperative PFE. Cornel et al. [World J Urol 23:353-355, 2005] determined the benefit of starting pelvic floor muscle exercise (PFE) 30 days before RP and of continuing PFE postoperatively for early recovery of continence as part of a randomised, prospective study (Moher quality A). This demonstrated preoperative PFE may improve early continence and QoL outcomes after RP. Post-prostatectomy incontinence is a bothersome complication of radical prostatectomy [Chughtai et al. in Rev Urol 15:61-66, 2013]. Weak pelvic floor muscles compromised normal pelvic floor function and led to urinary incontinence and erectile dysfunction. Strengthening the pelvic floor muscles was shown to significantly improve post-prostatectomy urinary continence, post-micturition dribble and erectile function. It would be prudent for all men to exercise their pelvic floor muscles to maintain normal pelvic floor function and start prior to surgery.
男性压力性尿失禁是机器人根治性前列腺切除术后的一种并发症。这是一个需要解决的主要问题，因为它对生活质量有很大影响，会影响患者的身体活动和社交福祉。我们对术前盆底肌锻炼（PFE）对前列腺切除术患者控尿结果影响的相关文献进行了系统综述。搜索策略旨在识别所有与盆底肌锻炼和前列腺切除术后相关的参考文献。使用的搜索词如下：（盆底肌锻炼）AND（尿失禁）AND（前列腺切除术）。对2000年至2017年9月期间的以下数据库进行了筛选：护理学与健康领域数据库（CINAHL）、医学文献数据库（MEDLINE，英国国家医疗服务体系证据库）、考克兰图书馆、澳大利亚医学数据库（AMed）、荷兰医学文摘数据库（EMBASE）、心理学文摘数据库（PsychINFO）、Scopus数据库、科学引文索引数据库（Web of Science）。此外，还使用考克兰数据库，通过医学主题词（MeSH）和关键词进行了搜索。咨询了两位英国的前列腺癌和机器人手术专家，以确定是否有其他研究。术后6个月，按照每天使用1片或更少尿垫来定义，盆底肌锻炼组和生物反馈组以及单纯盆底肌锻炼对照组的控尿率分别为94%（47例中的44例）和96%（50例中的48例）（P = 0.596）（Bales等人，《泌尿外科》，第56卷：627 - 630页，2000年）。这表明术前盆底肌锻炼可能会改善根治性前列腺切除术后的早期控尿情况。Geraerts等人（《欧洲泌尿外科杂志》，第64卷：766 - 772页，2013年）表明，“尿失禁影响”在术后3个月和6个月时有利于接受盆底肌锻炼的组。这再次证明了术前盆底肌锻炼的优势。Cornel等人[《世界泌尿外科杂志》，第23卷：353 - 355页，2005年]在一项随机前瞻性研究（质量等级为Moher A）中确定了在根治性前列腺切除术术前30天开始进行盆底肌锻炼（PFE）并在术后持续进行以促进控尿早期恢复的益处。这表明术前盆底肌锻炼可能会改善根治性前列腺切除术后的早期控尿情况和生活质量结果。前列腺切除术后尿失禁是根治性前列腺切除术的一个麻烦并发症[Chughtai等人，《泌尿外科综述》，第15卷：61 - 66页，2013年]。盆底肌薄弱会损害正常的盆底功能，导致尿失禁和勃起功能障碍。研究表明，加强盆底肌锻炼可显著改善前列腺切除术后的尿控、排尿后滴沥和勃起功能。所有男性都应明智地锻炼盆底肌以维持正常的盆底功能，并在手术前开始锻炼。
