Ficazzola M A, Nitti V W
Department of Urology, New York University School of Medicine, New York, USA.
J Urol. 1998 Oct;160(4):1317-20.
We evaluated men with post-radical prostatectomy incontinence to determine the incidence of intrinsic sphincter deficiency and bladder dysfunction, and the contribution of each to incontinence. In addition, we determined if subjective symptoms of stress urinary incontinence and urge incontinence correlated with urodynamic findings of intrinsic sphincter deficiency and bladder dysfunction, respectively.
A total of 60 consecutive patients (mean age 64.8 years) were prospectively evaluated with multichannel video urodynamics. All patients were evaluated at least 6 months postoperatively and had achieved a stable level of continence. Patients characterized incontinence as stress or urge related, and stress urinary incontinence was graded from 0 to 3. Intrinsic sphincter deficiency was defined as incontinence associated with increased intraabdominal pressure and was further assessed by Valsalva's leak point pressure. Bladder dysfunction included urodynamic findings of detrusor instability or decreased compliance.
Intrinsic sphincter deficiency was demonstrated in 54 patients (90%). Some component of bladder dysfunction was seen in 27 patients (45%), including detrusor instability in 24 and decreased compliance in 3, but incontinence was actually a result of bladder dysfunction in only 16 (27%). Incontinence was due to intrinsic sphincter deficiency alone in 40 patients (67%), intrinsic sphincter deficiency and bladder dysfunction in 14 (23%), and bladder dysfunction alone in only 2 (3%). Incontinence was not demonstrated on video urodynamics in 4 patients (7%). Of the 57 men who complained of stress urinary incontinence 54 demonstrated intrinsic sphincter deficiency for a positive predictive value of 95%. The 3 patients without stress urinary incontinence did not demonstrate intrinsic sphincter deficiency for a negative predictive value of 100%. Positive and negative predictive values for urge incontinence were 44 and 81%, respectively.
Incontinence after radical prostatectomy is associated with intrinsic sphincter deficiency in the overwhelming majority of patients. Bladder dysfunction rarely is an isolated cause. When present on urodynamic tests bladder dysfunction may not always be a significant contributor to incontinence. The symptom of stress urinary incontinence (or its absence) accurately predicts the finding (or absence) of intrinsic sphincter deficiency on urodynamics. Urge incontinence is not as reliable in predicting incontinence due to bladder dysfunction.
我们对根治性前列腺切除术后出现尿失禁的男性患者进行评估，以确定真性括约肌功能不全和膀胱功能障碍的发生率，以及二者对尿失禁的影响。此外，我们还确定了压力性尿失禁和急迫性尿失禁的主观症状是否分别与真性括约肌功能不全和膀胱功能障碍的尿动力学检查结果相关。
对60例连续患者（平均年龄64.8岁）进行前瞻性多通道影像尿动力学评估。所有患者均在术后至少6个月进行评估，且尿失禁程度已稳定。患者将尿失禁分为压力性或急迫性相关，并将压力性尿失禁从0到3级进行分级。真性括约肌功能不全定义为与腹内压升高相关的尿失禁，并通过瓦尔萨尔瓦漏点压进一步评估。膀胱功能障碍包括逼尿肌不稳定或顺应性降低的尿动力学检查结果。
54例患者（90%）存在真性括约肌功能不全。27例患者（45%）存在某种程度的膀胱功能障碍，其中24例为逼尿肌不稳定，3例为顺应性降低，但实际上只有16例（27%）的尿失禁是由膀胱功能障碍导致的。40例患者（67%）的尿失禁仅由真性括约肌功能不全引起，14例（23%）由真性括约肌功能不全和膀胱功能障碍引起，仅2例（3%）由膀胱功能障碍单独引起。4例患者（7%）影像尿动力学检查未显示尿失禁。在57例主诉压力性尿失禁的男性中，54例存在真性括约肌功能不全，阳性预测值为95%。3例无压力性尿失禁的患者未显示真性括约肌功能不全，阴性预测值为100%。急迫性尿失禁的阳性和阴性预测值分别为44%和81%。
根治性前列腺切除术后的尿失禁在绝大多数患者中与真性括约肌功能不全相关。膀胱功能障碍很少是孤立的病因。在尿动力学检查中出现膀胱功能障碍时，其不一定总是尿失禁的重要原因。压力性尿失禁症状（或无此症状）能准确预测尿动力学检查中真性括约肌功能不全的结果（或无此结果）。急迫性尿失禁在预测由膀胱功能障碍导致的尿失禁方面不太可靠。
