经闭孔尿道下吊带术：治疗前列腺切除术后各种程度尿失禁的一种安全有效的选择。

The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence.

作者信息

Sullivan John F, Stassen Paul N, Moran Diarmuid, Bolton Eva M, Smyth Lisa G, Browne Cliodhna M, Forde James C, Tal Raanan, Lynch Thomas H

机构信息

Department of Urological Surgery, St James's Hospital, Dublin, Ireland.

出版信息

Can J Urol. 2018 Apr;25(2):9268-9272.

PMID:29680005

Abstract

INTRODUCTION

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.

MATERIALS AND METHODS

A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.

RESULTS

Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).

CONCLUSIONS

Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

摘要

引言

根治性前列腺切除术后男性压力性尿失禁（SUI）很常见。传统的手术标准治疗方法是植入人工尿道括约肌（AUS），但自经闭孔男性吊带引入以来，已显示出其独特的优势。我们的目的是评估一系列连续的尿道下吊带植入术对不同程度的根治性前列腺切除术后SUI男性患者的治疗效果。

材料与方法

对一组连续接受根治性前列腺切除术后植入AdVance吊带的男性患者进行研究。评估的参数包括术前和术后的排尿功能、24小时尿垫使用情况、生活质量（QoL）结果、并发症及进一步治疗情况。根据每日尿垫使用情况，将尿失禁程度分为轻度（1 - 2片）、中度（3 - 5片）或重度（≥6片）。在术后1、4和6个月对患者进行复查。采用国际尿失禁咨询问卷简表（ICIQ - SF）评估症状严重程度和生活质量结果。

结果

纳入77例患者，平均年龄68岁，根治性前列腺切除术后至植入吊带的平均时间为34（8 - 113）个月。术前尿失禁程度：轻度占22%，中度占58%，重度占20%。14%的患者接受过根治性前列腺切除术后放疗（RT）。总体而言，73%的患者术后症状完全缓解，12%显著改善，15%尿垫使用无减少。60%的重度尿失禁患者被归类为治愈（无需使用尿垫或因安全原因使用1片干尿垫）。排除术前接受放疗的患者后，治愈率升至82%。在平均30个月的随访调查中，ICIQ - SF评分从基线的17.7（9 - 21.0）降至8.0（0 - 20）（p < 0.0001），95%置信区间为（8 - ）。