摘要
目的探讨前列腺术后尿失禁患者尿动力检查特点及其在病因诊断中的作用。方法回顾性分析中国康复研究中心北京博爱医院泌尿外科自2014年4月—2022年2月36例前列腺术后尿失禁患者资料。通过前列腺术后下尿路功能障碍症状、尿失禁对生活质量影响评分、影像尿动力检查参数及后期治疗方案选择等方面综合评估,比较不同病因前列腺术后尿失禁的特点及影像尿动力检查在诊疗方面的价值。结果患者平均年龄66.7岁,其中良性前列腺增生术后(TURP)患者20例(55.6%)、前列腺癌根治术后(RP)患者16例(44.4%)。尿动力检查显示,36例患者中61.1%存在尿道固有括约肌功能缺失(ISD)、41.7%存在逼尿肌过度活动(DO)。其中ISD为主导致尿失禁(UI)占33.3%,DO为主导致UI占22.2%。两组DO比例无统计学差异,而RP组存在ISD比例较TURP组更高,差异存在统计学意义(81.3%vs.45%,P=0.04)。36例患者中5例患者口服抗胆碱能制剂,1例行逼尿肌A型肉毒素注射术,8例行盆底肌训练,12例行人工尿道括约肌植入术。结论本研究数据显示尿道括约肌功能不全是前列腺术后尿失禁较常见的发病机制。膀胱功能障碍可能同时存在,也可能是尿失禁的单独原因。尿动力学研究对阐明前列腺术后患者尿失禁的确切原因是重要的。前列腺术后下尿路功能障碍病因的准确诊断及分析有助于诊疗方案的制定。
Objective To investigate the characteristics of urodynamics study(UDS)in patients with post-prostatectomy urinary incontinence(PPI)and its diagnostic role.Methods Clinical data of 36 PPI patients treated in our hospital during April 2014 and Feb.2022 were retrospectively analyzed.The symptoms of lower urinary tract dysfunction,impact of urinary incontinence on quality of life,UDS parameters and choice of treatment were evaluated.Characteristics of PPI with different causes were compared and the diagnostic value of UDS was analyzed.Results The average age of patients was 66.7 years.Sixteen patients(44.4%)developed PPI after radical prostatectomy(RP)and 20(55.6%)after transurethral resection of the prostate(TURP).UDS showed intrinsic sphincter dysfunction(ISD)in 61.1% patients,and detrusor overactivity(DO)in 41.7% patients.UI was caused mainly by ISD in 33.3% patients,and by DO in 22.2% patients.There was no statistically significant difference in the incidence of DO after RP or TURP;however,the RP group had a significantly higher incidence of ISD(81.3%vs.45%,P=0.04).Of the 36 patients,5 received anticholinergic agents,1 underwent botulinum toxin injection of detrusor type A,8 received pelvic floor muscle training and 12 underwent artificial urethral sphincter implantation.Conclusion s Sphincteric incompetence is the most common mechanism contributing to PPI.Bladder dysfunction may coexist or be an isolated cause of incontinence.Urodynamic studies are important to illustrate the exact causes of incontinence.Accurate diagnosis and analysis of the causes of lower urinary tract dysfunction after prostate surgery help the formulation of treatment strategy.
作者
张帆
廖利民
ZHANG Fan;LIAO Limin(Department of Urology,China Rehabilitation Research Center,Department of Urology of Capital Medical University,Department of Rehabilitation of Capital Medical University,Beijing 100068,China)
出处
《现代泌尿外科杂志》
CAS
2022年第9期768-773,共6页
Journal of Modern Urology
