Desautel M G, Kapoor R, Badlani G H
Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Neurourol Urodyn. 1997;16(3):153-60. doi: 10.1002/(sici)1520-6777(1997)16:3<153::aid-nau4>3.0.co;2-d.
Post-prostatectomy incontinence in patients with cancer of the prostate is often the result of sphincteric injury. However, recent studies have emphasized the role of detrusor instability and decreased bladder compliance in the etiology of post-prostatectomy incontinence. To further clarify the primary cause of incontinence, we reviewed the urodynamic studies of 39 patients referred for evaluation of incontinence after prostatectomy (35 radical, 4 TURP and radiation) for prostate cancer. Multichannel videourodynamic studies were performed to characterize bladder function, and sphincteric incontinence was assessed by Valsalva leak point pressure (VLPP). Flexible cystourethroscopy was used to evaluate the vesicourethral anastomosis. A pad scoring system was used to measure symptom severity. Sphincteric damage was found to be the sole cause of urinary incontinence in 23 patients (59%) and a major contributor in 14 others (36%). Twenty-seven patients (69%) had VLPP less than 103 cmH2O (mean = 55) with a urethral urodynamic catheter in place. An additional 10 (26%) had VLPP less than 150 cmH2O (mean = 63) upon removal of the catheter. VLPP is an indication of the severity of sphincteric damage. The importance of removing the urodynamic catheter during measurement of the VLPP is emphasized. Urethral fibrosis was confirmed by cystourethroscopy in 26 (67%) patients. Bladder dysfunction characterized by detrusor instability and/or decreased bladder compliance was seen in 15 patients (39%). In contrast to previous studies, our results indicate that sphincteric damage, and not bladder dysfunction, accounts for the vast majority of post-prostatectomy incontinence in patients with prostate cancer. However, it is essential to identify and treat bladder dysfunction in order to optimize the outcome of treatment for sphincteric incontinence.
前列腺癌患者前列腺切除术后的尿失禁通常是括约肌损伤的结果。然而，最近的研究强调了逼尿肌不稳定和膀胱顺应性降低在前列腺切除术后尿失禁病因中的作用。为了进一步阐明尿失禁的主要原因，我们回顾了39例因前列腺癌前列腺切除术后（35例根治性、4例经尿道前列腺切除术和放疗）转诊进行尿失禁评估患者的尿动力学研究。进行多通道视频尿动力学研究以表征膀胱功能，并通过瓦尔萨尔瓦漏尿点压力（VLPP）评估括约肌性尿失禁。使用软性膀胱尿道镜评估膀胱尿道吻合情况。采用护垫评分系统测量症状严重程度。发现23例患者（59%）尿失禁的唯一原因是括约肌损伤，另外14例患者（36%）中括约肌损伤是主要原因。27例患者（69%）在插入尿道尿动力学导管时VLPP小于103 cmH2O（平均 = 55）。另外10例患者（26%）在拔除导管后VLPP小于150 cmH2O（平均 = 63）。VLPP是括约肌损伤严重程度的一个指标。强调在测量VLPP时拔除尿动力学导管的重要性。26例（67%）患者经膀胱尿道镜证实存在尿道纤维化。15例患者（39%）出现以逼尿肌不稳定和/或膀胱顺应性降低为特征的膀胱功能障碍。与先前的研究不同，我们的结果表明，在前列腺癌患者中，前列腺切除术后尿失禁的绝大多数原因是括约肌损伤，而非膀胱功能障碍。然而，识别并治疗膀胱功能障碍对于优化括约肌性尿失禁的治疗效果至关重要。
