González-Chamorro F, Verdú Tartajo F, Durán Merino R, Lledo García E, Moncada Iribarren I, Diez Cordero J M, Herranz Amo F, Bueno Chomón G, Hernández Fernández C
Unidad de Urodinámica, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Arch Esp Urol. 1996 Mar;49(2):125-31.
To study the clinical and urodynamic parameters after radical prostatectomy in order to standardize the management of these patients in the medium-term.
35 cases submitted to radical prostatectomy from February, 1989 to March, 1994 were retrospectively evaluated clinically and urodynamically using a clinical questionnaire, free flowmetry, cystometry, pressure/flow voiding test with simultaneous videocystography and sacral-evoked potentials. The mean age was 65 years and mean follow-up was 14 months.
80% (28) were continent or minimally incontinent on exertion, 9% (3) required the use of some absorbent system and 11% (4) were completely incontinent and required the use of a collecting system. No statistical differences were observed between continence status and tumor stage, patient age or neurovascular preservation. Overall the urodynamic parameters fell within the normal ranges, except for a reduced maximum cystometric capacity. A significant difference (p = 0.05) was found in those patients with significant incontinence vs those who did not for maximum free flow, which disappeared on flowmetry with transducer catheter. Seventy per cent of the incontinent cases were evident on evaluation; 60% had stress incontinence and 40% had instability waves with differential pressure over 80 cm H2O. Six per cent met the criteria for obstruction, whose localization was done during videocystography. Eleven per cent showed non inhibited contractions and 6% showed diminished bladder compliance. The sacral reflex arch was normal in all patients.
The urodynamic study was found to be normal in the majority of patients submitted to radical prostatectomy; therefore performing the study routinely is not justified. However, incontinent patients and those with disturbances on free flowmetry may show incontinence due to instability or obstruction of the urethrovesical junction. We therefore advocate performing a complete study on all patients with significant incontinence and free flowmetry for the rest at least three months after surgery and a complete study should be done if disturbances are found.
研究根治性前列腺切除术后的临床和尿动力学参数，以便在中期规范对这些患者的管理。
对1989年2月至1994年3月期间接受根治性前列腺切除术的35例患者进行回顾性临床和尿动力学评估，采用临床问卷、自由尿流率测定、膀胱测压、同步膀胱造影的压力/流率排尿试验以及骶神经诱发电位。平均年龄为65岁，平均随访时间为14个月。
80%（28例）在用力时控尿或仅有轻微尿失禁，9%（3例）需要使用某种吸收系统，11%（4例）完全尿失禁且需要使用收集系统。在控尿状态与肿瘤分期、患者年龄或神经血管保留之间未观察到统计学差异。总体而言，除最大膀胱测压容量降低外，尿动力学参数均在正常范围内。在有明显尿失禁的患者与无明显尿失禁的患者之间，最大自由尿流率存在显著差异（p = 0.05），但使用传感器导管进行尿流率测定时该差异消失。70%的尿失禁病例在评估时明显；60%为压力性尿失禁，40%有不稳定波且压差超过80 cm H₂O。6%符合梗阻标准，其定位在膀胱造影时完成。11%表现为无抑制性收缩，6%表现为膀胱顺应性降低。所有患者的骶神经反射弧均正常。
发现大多数接受根治性前列腺切除术的患者尿动力学研究结果正常；因此常规进行该研究并无道理。然而，尿失禁患者和自由尿流率测定有异常的患者可能因尿道膀胱交界处不稳定或梗阻而出现尿失禁。因此，我们主张对所有有明显尿失禁的患者进行全面检查，对其余患者至少在术后三个月进行自由尿流率测定，如发现异常则应进行全面检查。
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