School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Urol Oncol. 2020 May;38(5):354-371. doi: 10.1016/j.urolonc.2019.12.007. Epub 2019 Dec 25.
Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.
尿失禁是根治性前列腺切除术后的常见问题。盆底肌训练提供了一个合理的解决方案。尽管早期的试验提供了有希望的结果，但系统评价对这种干预的疗效提出了质疑。一个主要的考虑因素是，尽管男女解剖结构存在差异，以及控尿/失禁的机制存在差异，但大多数针对男性的临床试验都应用了针对女性压力性尿失禁的盆底肌训练原则。关于男性控尿的文献一直存在争议，而且常常基于错误的解剖学。男性控尿机制的新认识，包括多层横纹盆底肌的复杂贡献，以及对根治性前列腺切除术后控尿解剖和生理学的详细考虑，为预防和治疗前列腺切除术后尿失禁提供了一种新的盆底肌训练方法。一种训练方法可以设计用于针对尿失禁的病理生理学。这种方法依赖于运动学习和运动生理学的原则，以适应个体患者的特点。本文的目的是考虑男性控尿机制的新认识、根治性前列腺切除术后尿失禁的机制，并回顾专门针对前列腺切除术后恢复控尿而设计的盆底肌训练计划的特点。
