Martins F E, Bennett C J, Dunn M, Filho D, Keller T, Lieskovsky G
Department of Urology, University of Southern California School of Medicine, Los Angeles, USA.
J Urol. 1997 Nov;158(5):1745-9. doi: 10.1016/s0022-5347(01)64116-8.
We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-radical prostatectomy incontinence.
A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radical retropubic prostatectomy, underwent a mean of 2.8 transurethral injections of collagen (mean cumulative volume injected 31 ml.). Preoperatively, all patients underwent fluoroscopic multichannel video urodynamics including determination of Valsalva's leak point pressure. Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patient age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections, total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlated with treatment outcome.
Of the patients 11 (24%) became completely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 after 3 or fewer treatments) and 14 (30%) showed no benefit (after more than 3 treatments). Of the 14 patients in whom treatment failed 6 had undergone adjuvant radiation treatment, pretreatment urinary incontinence was grade 3 in all, and concomitant detrusor instability was present in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 ml.).
Notwithstanding the need for multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly affected by the severity of pretreatment incontinence, concomitant detrusor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.
我们确定并描述了与根治性前列腺切除术后尿失禁患者胶原注射治疗不良结局相关的预测因素。
共有46例年龄在49至85岁（平均年龄67岁）、根治性耻骨后前列腺切除术后出现尿失禁的患者，平均接受了2.8次经尿道胶原注射（平均累计注射量31毫升）。术前，所有患者均接受了荧光多通道视频尿动力学检查，包括测定瓦尔萨尔瓦漏点压。压力性尿失禁主观分级为1级（每天0至1片尿垫）、2级（每天2至3片尿垫）和3级（每天超过3片尿垫）。评估患者年龄、治疗前尿失禁的持续时间和严重程度、逼尿肌不稳定和吻合口狭窄的存在情况、注射次数、输送的胶原总量以及保留神经手术加辅助放疗的影响，并将其与治疗结局相关联。
在这些患者中，11例（24%）完全治愈（9例在3次或更少治疗后治愈），21例（41%）病情改善（17例在3次或更少治疗后改善），14例（30%）无改善（在超过3次治疗后）。在治疗失败的14例患者中，6例接受了辅助放疗，所有患者治疗前尿失禁均为3级，11例（79%）伴有逼尿肌不稳定。所有患者均接受了超过3次治疗（平均总注射量37毫升）。
尽管需要多次治疗，但根治性前列腺切除术后尿失禁患者通过胶原注射治愈的前景受到治疗前尿失禁严重程度、伴发的逼尿肌过度活动和放疗的显著影响。年龄、尿失禁持续时间、轻至中度吻合口狭窄的存在以及保留神经技术似乎不影响治疗结局。
