Ramon J, Leandri P, Rossignol G, Gautier J R
Department of Urology, Saint-Jean Languedoc, Toulouse, France.
Br J Urol. 1993 Jan;71(1):47-51. doi: 10.1111/j.1464-410x.1993.tb15879.x.
Between 1983 and 1989, 484 men (46-82 years old) underwent radical retropubic prostatectomy for prostate cancer. Six months after surgery, 434 patients (90%) achieved complete urinary control; stress incontinence was present in 50 patients (10%) and no patient was totally incontinent. Of the 398 patients who were followed up for more than 1 year, 377 (95%) achieved complete urinary control and 21 (5%) experienced stress incontinence. Prior open prostatectomy or transurethral resection of the prostate had no influence on the return of urinary control. Pathological stage and preservation or not of the neurovascular bundles also had no significant influence on the long-term state of continence. Age was the only factor that adversely affected the return of urinary continence. The average interval between surgery and return of continence was shorter in patients less than 70 years old. When the impact of age was examined 1 year or more after surgery, no significant difference was noted between the age groups. Several technical considerations that contribute to these results are discussed, especially the use of a gradual approach to the apex of the prostate to facilitate exposure and haemostasis and to preserve as much of the striated urethral sphincter as possible.
1983年至1989年间，484名男性（46 - 82岁）因前列腺癌接受了耻骨后根治性前列腺切除术。术后6个月，434例患者（90%）实现了完全控尿；50例患者（10%）存在压力性尿失禁，无患者完全失禁。在398例随访超过1年的患者中，377例（95%）实现了完全控尿，21例（5%）出现压力性尿失禁。既往开放性前列腺切除术或经尿道前列腺切除术对控尿恢复无影响。病理分期以及神经血管束的保留与否对长期控尿状态也无显著影响。年龄是唯一对尿失禁恢复产生不利影响的因素。年龄小于70岁的患者，手术至控尿恢复的平均间隔时间较短。在术后1年或更长时间检查年龄的影响时，各年龄组之间未发现显著差异。本文讨论了促成这些结果的几个技术要点，特别是采用逐步处理前列腺尖部的方法，以利于暴露和止血，并尽可能保留更多的尿道横纹括约肌。
