Lowe B A
Oregon Health Sciences University, Portland, USA.
J Urol. 1997 Dec;158(6):2137-41. doi: 10.1016/s0022-5347(01)68180-1.
The impact was determined on post-prostatectomy urinary incontinence of a technique preserving the anterior attachments of the proximal urethra to the posterior pubis by comparison to the results of other surgical methods.
Urinary continence in 51 patients undergoing preservation of the anterior urethral attachments was compared to that of 70 patients undergoing an anatomical prostatectomy with resection of the bladder neck, 55 patients with preservation of the bladder neck and 14 patients undergoing a dorsal vein gathering procedure. Comparisons were made for rate of total continence, time to return of continence, incidence of extra organ disease and operative blood loss.
Total continence at 1 year was 84.3%, 89.1%, 85.7% and 100% respectively. Immediate total continence after catheter removal was seen in 25.5% after preservation of the anterior urethral attachments, 80.4% at 3 months compared to 41.4%, 50.9% and 50% at 3 months for anatomical prostatectomy with bladder neck resection, preservation and dorsal vein gathering. Clinical staging with the incidence of specimen confined disease was similar in all groups. Mean operative blood loss was 1,031 ml. for those patients undergoing anatomical prostatectomy compared to 681 ml. for those with preservation of the anterior urethral attachments.
Preservation of the anterior urethral attachments results in improved urinary continence and lower operative blood loss without an increase in positive surgical margins.
通过与其他手术方法的结果进行比较，确定保留近端尿道至耻骨后缘前部附着结构的技术对前列腺切除术后尿失禁的影响。
将51例行保留尿道前部附着结构手术患者的尿控情况，与70例行解剖性前列腺切除术并切除膀胱颈的患者、55例行保留膀胱颈手术的患者以及14例行背静脉结扎术患者的尿控情况进行比较。比较了完全控尿率、控尿恢复时间、器官外疾病发生率和手术失血量。
1年时的完全控尿率分别为84.3%、89.1%、85.7%和100%。保留尿道前部附着结构后，拔管后立即完全控尿的比例为25.5%，3个月时为80.4%；而行解剖性前列腺切除术并切除膀胱颈、保留膀胱颈及背静脉结扎术的患者，3个月时的相应比例分别为41.4%、50.9%和50%。所有组标本局限疾病的临床分期发生率相似。解剖性前列腺切除术患者的平均手术失血量为1031 ml，而保留尿道前部附着结构的患者为681 ml。
保留尿道前部附着结构可改善尿控并减少手术失血量，且不会增加手术切缘阳性率。
