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根治性前列腺切除术后尿失禁的盆底康复治疗。

PELVIC REHABILITATION FOR URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY.

机构信息

Department of urology, University Hospital Centre Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia.

Department of Rheumatology and Rehabilitation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia.

出版信息

Acta Clin Croat. 2022 Oct;61(Suppl 3):71-75. doi: 10.20471/acc.2022.61.s3.10.

Abstract

Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries the risk of postprostatectomy urinary incontinence (UI) and erectile dysfunction (ED) which significantly reduce patients' satisfaction with surgery and quality of life (QoL), therefore it is important to decrease the possibility or severity of these complications to a minimum. There are several preoperative prognostic factors such as urethral length and closing pressure obtained by magnetic resonance imaging and profilometry, as well as several variations in the surgical approach such as preservation of the neurovascular bundle (NVB) and puboprostatic ligaments, sparing or reconstruction of bladder neck, Retzius-sparing approach, and meticulous surgical dissection, used to predict or prevent unwanted side effects of RP. In addition, there are postoperative methods that can help reduce complications. In this review, we will present the role of pelvic rehabilitation with an emphasis on pelvic floor muscle training (PFMT) in reducing consequences of radical surgery.

摘要

根治性前列腺切除术(RP)经开放、腹腔镜或机器人方法进行,被认为是局限性前列腺癌(PCa)的金标准。然而,它存在前列腺切除术后尿失禁(UI)和勃起功能障碍(ED)的风险,这会显著降低患者对手术的满意度和生活质量(QoL),因此,将这些并发症的可能性或严重程度降至最低非常重要。有几种术前预后因素,如磁共振成像和轮廓测量获得的尿道长度和闭合压力,以及手术方法的几种变化,如保留神经血管束(NVB)和耻骨前列腺韧带、保留或重建膀胱颈部、保留Retzius 间隙的方法和精细的手术解剖,用于预测或预防 RP 的不良副作用。此外,还有一些术后方法可以帮助减少并发症。在这篇综述中,我们将介绍骨盆康复的作用,重点是盆底肌肉训练(PFMT)在减少根治性手术后果方面的作用。

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本文引用的文献

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[Economic importance of postoperative urinary incontinence].[术后尿失禁的经济重要性]
Urologe A. 2015 Nov;54(11):1564, 1566-8. doi: 10.1007/s00120-015-3856-6.
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Conservative management for postprostatectomy urinary incontinence.前列腺切除术后尿失禁的保守治疗
Cochrane Database Syst Rev. 2015 Jan 20;1(1):CD001843. doi: 10.1002/14651858.CD001843.pub5.

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