Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Can J Urol. 2021 Aug;28(S2):38-43.
INTRODUCTION Men who undergo treatment for prostate disease are at increased risk of urinary incontinence (UI). UI has a known negative impact on patient quality of life. Once a thorough evaluation has been performed, there are effective modalities for treatment that can be tailored to the patient.
This review article provides the most recent evidence-based work up and management for men with incontinence after prostate treatment (IPT). Etiology, prophylactic measures, work up, surgical treatments, and patient considerations will be covered. The more recent adjustable balloon device is included in this publication as well as more traditional treatments like the artificial urinary sphincter (AUS) and male urethral sling.
IPT can result from treatment of either benign or malignant prostate disease whether surgery or radiotherapy are utilized. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) are all possibilities. SUI after radical prostatectomy (RP) is the most common form of IPT. Patient education and implementation of pelvic therapy as well as modern surgical techniques have greatly improved continence results. AUS remains the gold standard of SUI treatment with the broadest category of patient eligibility. Patients experiencing UUI should be treated according to the overactive bladder guidelines.
For men with IPT, it is crucial to first take a thorough patient history and delineate the exact nature of UI symptoms which will determine the options for management. Patient factors and preferences must also be taken into consideration when ultimately choosing the appropriate intervention.
介绍 背景：接受前列腺疾病治疗的男性发生尿失禁（UI）的风险增加。UI 已知会对患者的生活质量产生负面影响。一旦进行了彻底的评估，就可以针对患者选择有效的治疗方法。 材料和方法：本文综述了治疗前列腺治疗后（IPT）男性尿失禁的最新循证检查和管理方法。涵盖了病因、预防措施、检查、手术治疗和患者注意事项。本文还包括了更近期的可调节球囊装置，以及更传统的治疗方法，如人工尿道括约肌（AUS）和男性尿道吊带。 结果：IPT 可由良性或恶性前列腺疾病的治疗引起，无论是手术还是放疗。可能出现压力性尿失禁（SUI）、急迫性尿失禁（UUI）或混合性尿失禁（MUI）。根治性前列腺切除术（RP）后发生的 SUI 是最常见的 IPT 形式。患者教育和实施盆腔治疗以及现代手术技术极大地提高了控尿效果。AUS 仍然是 SUI 治疗的金标准，适用于最广泛的患者群体。有 UUI 症状的患者应根据膀胱过度活动症指南进行治疗。 结论：对于患有 IPT 的男性，首先需要详细了解患者的病史并明确 UI 症状的性质，这将决定管理方案的选择。在最终选择合适的干预措施时，还必须考虑患者因素和偏好。
