Theodorou C, Moutzouris G, Floratos D, Plastiras D, Katsifotis C, Mertziotis N
Urology Department, Polycliniki Hospital, Athens, Greece.
Eur Urol. 1998;33(4):370-5. doi: 10.1159/000019618.
Whether incontinence after surgery for benign prostatic hypertrophy (BPH) requires simple workup and treatment or being a more complex condition and multifactorial in etiology requiring combined surgical techniques should be investigated in more detail.
We retrospectively reviewed the records of 56 patients referred to us for post-prostatectomy incontinence after surgery for BPH. All patients were subjected to urodynamics. Twenty-three (41.1%) patients required additional ascending urethrogram and/or cystourethroscopy, according to their associated symptomatology and the urodynamic findings, for a definitive diagnosis to be established.
Twenty-four patients (42.8%) were found to have complex incontinence (either mixed or any type associated with bladder outlet stenosis), requiring combined treatment. Twenty-three (41.1%) had a simple type of incontinence, i.e., pure sphincter incompetence or unstable detrusor. Three patients had residual adenoma and 1 urethral stricture, while 5 patients (8.9%) remained unclassified. Thirty-seven patients were subjected to treatment, 27 (73%) of them to single-modality treatment (artificial urinary sphincter insertion, oxybutynin chloride, transurethral prostatectomy, optical urethrotomy) and the other 10 (27%) to combined treatment (artificial urinary sphincter insertion plus urethroplasty, ileocystoplasty, permanent urethral stent implantation etc.). The overall socially acceptable continence rate (cured plus significantly improved) of the patients subjected to artificial urinary sphincter insertion reached 85%, being better (90%) for the uncomplicated sphincter incompetence group.
Incontinence after surgery for BPH represents a condition that requires careful evaluation. In a significant proportion of patients, a combination of prosthetic and reconstructive techniques is needed for an optimal result to be achieved.
良性前列腺增生（BPH）手术后的尿失禁是需要简单的检查和治疗，还是一种更复杂、病因多因素且需要联合手术技术的情况，应进行更详细的研究。
我们回顾性分析了56例因BPH手术后前列腺切除术后尿失禁前来就诊的患者的记录。所有患者均接受了尿动力学检查。根据相关症状和尿动力学检查结果，23例（41.1%）患者需要额外进行逆行尿道造影和/或膀胱尿道镜检查，以明确诊断。
24例（42.8%）患者被发现患有复杂尿失禁（混合性或与膀胱出口狭窄相关的任何类型），需要联合治疗。23例（41.1%）患者患有简单类型的尿失禁，即单纯括约肌功能不全或逼尿肌不稳定。3例患者有残留腺瘤和1例尿道狭窄，5例患者（8.9%）仍未分类。37例患者接受了治疗，其中27例（73%）接受了单一治疗方式（人工尿道括约肌植入、氯化奥昔布宁、经尿道前列腺切除术、光学尿道切开术），另外10例（27%）接受了联合治疗（人工尿道括约肌植入加尿道成形术、回肠膀胱成形术、永久性尿道支架植入等）。接受人工尿道括约肌植入的患者总体社会可接受的控尿率（治愈加显著改善）达到85%，单纯括约肌功能不全组更好（90%）。
BPH手术后的尿失禁是一种需要仔细评估的情况。在相当一部分患者中，需要假体和重建技术相结合才能取得最佳效果。
