Goluboff E T, Chang D T, Olsson C A, Kaplan S A
Department of Urology, Squier Urologic Clinic, Columbia-Presbyterian Medical Center, New York, New York.
J Urol. 1995 Mar;153(3 Pt 2):1034-7.
Post-prostatectomy incontinence is a disabling disorder. Urodynamic studies in 56 patients with post-prostatectomy incontinence were reviewed to determine its etiology. Of the patients 31 had undergone transurethral prostatectomy and 25 radical retropubic prostatectomy. After careful history and neurourological examination, uroflowmetry, post-void residual determination and synchronous multichannel video pressure/flow studies were done. The most common etiology for incontinence was detrusor instability alone, which was present in 34 patients (61%), including 24 (77%) after transurethral resection of the prostate and 10 (40%) after radical retropubic prostatectomy. Stress incontinence alone was present in only 3 patients (5%), including 1 (3%) after transurethral resection of the prostate and 2 (8%) after radical retropubic prostatectomy. Detrusor instability with stress incontinence was present in 19 patients (34%), including 6 (19%) after transurethral resection of the prostate and 13 (52%) after radical retropubic prostatectomy. Of these 19 patients 4 (21%) had poorly compliant bladders. This study demonstrates that stress incontinence alone is a relatively rare cause of post-prostatectomy incontinence, with detrusor instability present in more than 90% of the patients. Accurate diagnosis of post-prostatectomy incontinence etiology could ensure proper treatment for this disorder.
前列腺切除术后尿失禁是一种致残性疾病。回顾了56例前列腺切除术后尿失禁患者的尿动力学研究以确定其病因。这些患者中，31例行经尿道前列腺切除术，25例行耻骨后根治性前列腺切除术。在详细询问病史和进行神经泌尿学检查后，进行了尿流率测定、排尿后残余尿量测定以及同步多通道视频压力/流率研究。尿失禁最常见的病因是单纯逼尿肌不稳定，34例患者（61%）存在该情况，其中经尿道前列腺电切术后24例（77%），耻骨后根治性前列腺切除术后10例（40%）。仅存在压力性尿失禁的患者只有3例（5%），包括经尿道前列腺电切术后1例（3%），耻骨后根治性前列腺切除术后2例（8%）。逼尿肌不稳定合并压力性尿失禁的患者有19例（34%），其中经尿道前列腺电切术后6例（19%），耻骨后根治性前列腺切除术后13例（52%）。这19例患者中有4例（21%）膀胱顺应性差。本研究表明，单纯压力性尿失禁是前列腺切除术后尿失禁相对少见的病因，超过90%的患者存在逼尿肌不稳定。准确诊断前列腺切除术后尿失禁的病因可确保对该疾病进行恰当治疗。
