Satyanarayan Arthi, Mooney Ryan, Singla Nirmish
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Eur Med J Urol. 2016 Apr;4(1):75-80.
Post-prostatectomy incontinence (PPI) is a common and significant issue that can affect the quality of life in men who are undergoing treatment for prostate cancer. While some patients opt for conservative management of their incontinence, many elect to undergo surgical treatment as a result of the significant impact to quality of life. The most commonly employed surgical techniques to address PPI are placement of a male sling or artificial urinary sphincter (AUS). Currently, the AUS continues to serve as the gold standard for management, with robust data concerning longitudinal outcomes available. However, in recent years, the various methods to place the male sling have emerged as viable, less complex alternatives that avoid the need for pump manipulation. In the present review, we discuss these main surgical treatment modalities for PPI, and focus on the selection criteria that may influence appropriate operative stratification of PPI patients. Indeed, an individualised, comprehensive assessment of baseline urinary function, age, radiation, prior surgeries, functional status, and other comorbidities must be considered in the context of shared decision-making between the treatment provider and the patient in determining the optimal approach to managing PPI.
前列腺切除术后尿失禁（PPI）是一个常见且重要的问题，会影响接受前列腺癌治疗的男性的生活质量。虽然一些患者选择对尿失禁进行保守治疗，但由于对生活质量有重大影响，许多患者选择接受手术治疗。解决PPI最常用的手术技术是放置男性吊带或人工尿道括约肌（AUS）。目前，AUS仍然是治疗的金标准，有关于长期结果的可靠数据。然而，近年来，放置男性吊带的各种方法已成为可行的、不太复杂的替代方案，避免了泵操作的需要。在本综述中，我们讨论了PPI的这些主要手术治疗方式，并重点关注可能影响PPI患者适当手术分层的选择标准。事实上，在治疗提供者和患者共同决策确定管理PPI的最佳方法时，必须在基线尿功能、年龄、放疗、既往手术、功能状态和其他合并症的背景下进行个体化、全面的评估。
