Department of Urology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Ann Surg Oncol. 2024 Nov;31(12):8444-8459. doi: 10.1245/s10434-024-16110-1. Epub 2024 Aug 31.
Radical prostatectomy and radiotherapy are common first-line treatments for clinically localized prostate cancer. Despite advances in surgical technology and multidisciplinary management, post-prostatectomy urinary incontinence (PPI) remains a common clinical complication. The incidence and duration of PPI are highly heterogeneous, varying considerably between individuals. Post-prostatectomy urinary incontinence may result from a combination of factors, including patient characteristics, lower urinary tract function, and surgical procedures. Physicians often rely on detailed medical history, physical examinations, voiding diaries, pad tests, and questionnaires-based symptoms to identify critical factors and select appropriate treatment options. Post-prostatectomy urinary incontinence treatment can be divided into conservative treatment and surgical interventions, depending on the severity and type of incontinence. Pelvic floor muscle training and lifestyle interventions are commonly conservative strategies. When conservative treatment fails, surgery is frequently recommended, and the artificial urethral sphincter remains the "gold standard" surgical intervention for PPI. This review focuses on the diagnosis and treatment of PPI, based on the most recent clinical research and recommendations of guidelines, including epidemiology and risk factors, diagnostic methods, and treatment strategies, aimed at presenting a comprehensive overview of the latest advances in this field and assisting doctors in providing personalized treatment options for patients with PPI.
根治性前列腺切除术和放疗是临床局限性前列腺癌的常见一线治疗方法。尽管手术技术和多学科管理取得了进展,但前列腺癌根治术后尿失禁(PPI)仍然是一种常见的临床并发症。PPI 的发生率和持续时间高度异质,个体之间差异很大。前列腺癌根治术后尿失禁可能是多种因素共同作用的结果,包括患者特征、下尿路功能和手术过程。医生通常依赖详细的病史、体格检查、排尿日记、垫试验和基于问卷的症状来确定关键因素并选择合适的治疗方案。根据尿失禁的严重程度和类型,前列腺癌根治术后尿失禁的治疗可分为保守治疗和手术干预。盆底肌肉训练和生活方式干预是常见的保守策略。当保守治疗失败时,通常会推荐手术,而人工尿道括约肌仍然是 PPI 的“金标准”手术干预措施。本综述基于最新的临床研究和指南建议,重点介绍了 PPI 的诊断和治疗,包括流行病学和危险因素、诊断方法以及治疗策略,旨在全面介绍该领域的最新进展,并帮助医生为 PPI 患者提供个性化的治疗选择。