Kaye K W, Creed K E, Wilson G J, D'Antuono M, Dawkins H J
Urological Research Centre of Western Australia, Australia.
Br J Urol. 1997 Sep;80(3):444-501. doi: 10.1046/j.1464-410x.1997.00373.x.
To assess the effects of three types of apical dissection on urinary continence after radical retropubic prostatectomy and to evaluate possible contributing factors, e.g. preservation of the bladder neck and preprostatic sphincter, age, anastomotic strictures, previous transurethral resection and nerve-sparing surgery.
Having undergone one of three types of apical dissection, 280 patients were evaluated: in Group 1 (sphincter-damaging) 134 patients underwent the original technique of ligating and transecting the venous complex; in Group 2 (sphincter-repairing), 76 patients had the venous complex with part of striated sphincter incorporated within anastomotic suture(s); and in Group 3 (sphincter-preserving), 70 patients had the venous complex alone ligated using the 'bunching' technique of Myers. The outcome was analysed for the number becoming continent and the time to continence.
Continence was achieved in 93% overall, with 90%, 93% and 99% achieving continence in Groups 1, 2 and 3, respectively. The mean time to continence was 68 days overall, taking 100, 52 and 30 days for the respective groups. Twenty patients (7%) did not achieve full continence; 15 had minor incontinence and five severe, with none of the latter being in Group 3. The group (preservation of external sphincter), age and freedom from development of anastomotic strictures were the most important factors both in regaining continence and decreasing the time to continence.
Preservation of as much as possible of the normal anatomy of the sphincter mechanisms and their nerve supplies results in an excellent return to continence after radical retropubic prostatectomy.
评估三种类型的尖部解剖对耻骨后根治性前列腺切除术后尿控的影响，并评估可能的影响因素，如膀胱颈和前列腺前括约肌的保留、年龄、吻合口狭窄、既往经尿道切除术和保留神经手术。
对接受三种类型尖部解剖之一的280例患者进行评估：第1组（括约肌损伤组）134例患者采用结扎并横断静脉丛的原始技术；第2组（括约肌修复组）76例患者将静脉丛与部分横纹肌括约肌纳入吻合缝线；第3组（括约肌保留组）70例患者采用迈尔斯的“束扎”技术单独结扎静脉丛。分析尿控恢复的例数和尿控恢复时间。
总体尿控率为93%，第1、2、3组的尿控率分别为90%、93%和99%。总体尿控恢复的平均时间为68天，各组分别为100天、52天和30天。20例患者（7%）未完全恢复尿控；15例轻度尿失禁，5例重度尿失禁，第3组无重度尿失禁患者。保留外括约肌、年龄和无吻合口狭窄是恢复尿控和缩短尿控恢复时间的最重要因素。
尽可能保留括约肌机制及其神经供应的正常解剖结构，可使耻骨后根治性前列腺切除术后尿控恢复良好。
