前列腺癌根治术后尿失禁康复训练方案的构建

目的 构建前列腺癌根治术后尿失禁康复训练方案,为科学管理术后尿失禁提供参考.方法 在文献研究、病例回顾分析及小组会议法基础上,通过Delphi法确定前列腺癌根治术后尿失禁康复训练方案的具体内容.结果 2轮专家咨询问卷有效回收率均为100％,专家权威系数分别为0.832、0.851,变异系数分别为0～0.257、0～0.210,肯德尔和谐系数分别为0.269、0.280(均P＜0.01).构建的前列腺癌根治术后尿失禁康复训练方案包括3个阶段43个条目.结论 本研究构建的前列腺癌根治术后尿失禁康复训练方案具有可靠性及实用性,可为临床开展前列腺癌根治术后尿失禁康复训练提供参考.     

前列腺癌根治术后尿失禁预防及治疗的研究进展

尿失禁(UI)是前列腺癌根治术(RP)后的常见并发症之一,严重影响患者术后的生活质量。RP术后尿控的恢复与患者术前的基本情况、手术方案以及有效的术后管理相关。RP术后UI的治疗方法包括生活方式干预、盆底肌功能锻炼、药物等保守治疗以及人工尿道括约肌(AUS)植入术、填充剂注射术、尿道压迫及吊带术等外科治疗。干细胞治疗压力性尿失禁(SUI)因其微创、高效日益受到人们重视,有研究表明干细胞治疗RP术后SUI同样有效。本文主要对RP后UI预防和治疗方面的研究进展作一综述。     

提高前列腺癌根治术后尿控能力的临床研究

目的：探讨提高前列腺癌根治术后尿控能力的方法。方法：对15例前列腺癌采用保留尿道膜部括约肌及前列腺侧旁神经血管束的方法进行前列腺癌根治术。结果：经6—45个月随访，15例患者排尿通畅，无肿瘤复发，除1例有轻度尿失禁外，余14例6个月内均恢复尿控能力。结论：保留尿道膜部括约肌及前列腺侧旁神经血管束的方法能减低前列腺癌根治术后尿失禁。     

综合护理干预对乳腺癌根治术后患者婚姻质量的影响

目的探讨有效的综合护理干预措施对乳腺癌根治术后患者婚姻质量的影响。方法将100例乳腺癌根治术患者随机分为干预组和对照组各50例。对照组行常规护理;干预组由经过专门培训的护士根据患者及配偶年龄、文化程度,制定综合护理干预措施,对患者本人及配偶进行系统的心理疏导、康复知识健康教育及认知行为干预。于干预前和干预3个月后采用Olson婚姻质量问卷对患者的婚姻质量进行调查。结果干预3个月后干预组婚姻质量评分显著高于对照组(均P0.05)。结论对乳腺癌根治术后患者加强有针对性和个性化的综合护理干预措施,可明显改善患者婚姻质量,有助于提高其身心健康和婚姻质量。     

综合护理干预对乳腺癌根治术后患者婚姻质量的影响

目的探讨有效的综合护理干预措施对乳腺癌根治术后患者婚姻质量的影响。方法将100例乳腺癌根治术患者随机分为干预组和对照组各50例。对照组行常规护理;干预组由经过专门培训的护士根据患者及配偶年龄、文化程度,制定综合护理干预措施,对患者本人及配偶进行系统的心理疏导、康复知识健康教育及认知行为干预。于干预前和干预3个月后采用Olson婚姻质量问卷对患者的婚姻质量进行调查。结果干预3个月后干预组婚姻质量评分显著高于对照组（均P〈0.05）。结论对乳腺癌根治术后患者加强有针对性和个性化的综合护理干预措施,可明显改善患者婚姻质量,有助于提高其身心健康和婚姻质量。     

前列腺癌根治术中保护控尿功能的体会

目的：减少耻骨后前列腺癌根治术患者术后尿失禁发生率。方法：对16例B超前列腺癌患者行保护控尿功能的解剖性耻骨后前列腺癌根治术。结果：16例术后随访3个月-5年，平均13个月。膀胱控尿正常者13例，轻度压力性尿失禁者2例，严重尿失禁者1例。结论：在行耻骨后前列腺癌根治术时，认识尿道括约肌及其支配神经的解剖位置及结构，避免对其损伤可以减少术后尿失禁发生率。     

多形式延续护理对前列腺癌根治术患者焦虑及生活质量的影响

目的探讨多形式延续护理对前列腺癌根治术患者焦虑情绪、术后并发症和生活质量的影响。方法将112例前列腺癌根治术患者随机分为观察组和对照组各56例。对照组给予常规护理和出院指导,观察组在此基础上实施多形式延续护理。出院前及出院后不同时间测评患者焦虑程度、生活质量,并统计尿失禁改善情况。结果出院后1、3、6个月观察组焦虑程度显著低于对照组,出院后6个月生活质量评分及术后尿失禁改善情况显著优于对照组(P0.05,P0.01)。结论对前列腺癌根治术患者出院后实施多形式延续护理,可以显著改善患者焦虑情绪,促进患者康复,提高其生活质量。     

提高腹腔镜前列腺癌根治术后控尿的临床研究

目的 分析总结腹腔镜前列腺癌根治术51例手术控尿技术的经验.方法 回顾性总结腹腔镜前列腺癌根治术患者51例.术前均病理证实前列腺癌诊断.T la～1b 4例(8%),T 1c 15例(29%),T2a 7例(14%),T2b 5例(10%),T2c 20例(39%).结果 腹腔镜下成功完成前列腺癌根治术49例.术后发生尿漏3例,均自愈.术后尿管留置14～45 d,平均16 d.术后随访3～53个月,平均17个月.术后3个月随访51例患者,13例尿失禁;术后6个月随访39例患者,7例尿失禁;术后12个月随访患者20例,5例尿失禁,其中完全性尿失禁1例.前20例和后31例在术后3个月时尿失禁发生率分别为6/20(30%)和7/31(22%),差异有统计学意义(P<0.05).直肠损伤2例,行结肠造口术.术后复发2例,一例行内分泌治疗后停药.另一例肺转移手术后死亡.其余病例前列腺特异抗原<0.2μL.结论 腹腔镜前列腺癌根治术治疗局限性前列腺癌是安全、有效的.术后控尿功能主要与术中前列腺尖部、耻骨前列腺韧带和神经血管束的处理及手术经验相关.     

基于循证理论的延续性护理在前列腺癌患者术后尿失禁中的应用效果

<正>前列腺癌(prostate cancer, PCa)是最常见的男性恶性肿瘤之一,也是导致男性癌症相关死亡的第二大原因^[1]。虽然我国的PCa发生率仍然处于较低水平,但由于患者就诊时多为晚期,因此五年生存率远低于欧美等发达国家^[2]。全球癌症统计数据显示,我国PCa的新发病例人数和相关死亡人数分别占据全球新发病例数和相关死亡人数的8.2%和13.6%^[3]。随着人口老龄化程度的加剧,PCa的发病率呈现出逐年递增的趋势,     

Pathophysiology of urinary incontinence after radical prostatectomy

To define the origin of urinary incontinence after radical prostatectomy urodynamic studies in 24 incontinent patients were compared to those of 13 continent patients. A statistically significant difference between incontinent and continent patients was found for the mean functional profile length (2.1 versus 3.6 cm., respectively, p less than 0.001), maximal urethral closure pressure (39 versus 74 cm. water, respectively, p less than 0.001) and maximal urethral closure pressure during voluntary contraction of the external sphincter (107 versus 172 cm. water, respectively, p less than 0.002). The differences among maximal detrusor pressure, initial bladder volume at which a detrusor contraction occurs, maximal cystometric capacity and residual urine were not statistically significant between the 2 groups. Urethral instability was present in 1 of the 24 incontinent patients (4.2%) and in none of the 13 continent patients, while detrusor instability was present in 6 (25%) and 3 (23.1%), respectively. Urethral and detrusor instability correlated poorly with incontinence (correlation coefficients 0.123 and 0.021, respectively). The appearance of the bladder outlet on voiding cystourethrography was correlated with urodynamic parameters and the presence or absence of continence. Tubularization above the level of the external sphincter was present in continent but absent in incontinent patients. Continence after radical prostatectomy is dependent upon sphincteric efficiency, which may be influenced by the anatomical configuration of the reconstructed bladder outlet and the integrity of the distal urethral sphincteric mechanism.     

The management of stress urinary incontinence after radical prostatectomy

Up to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects <5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.     

A study of urinary incontinence after prostatectomy

With respect to prostatectomies carried out in clinic since the opening of the Kinki University Hospital in 1975, incontinence after prostatectomy was investigated with 470 patients as subjects for whom a follow-up study after the operation was possible. Also, the usefulness of the urodynamic tests for diagnosing underlying diseases was investigated. 1) Overall incidence of incontinence after transurethral resection of the prostate (TUR-P), retropubic prostatectomy (RPP) and cryoprostatectomy was 5.7 percent. 2) The incidence of incontinence was 7.1 percent of the patients with TUR-P and 3.5 percent of patients with RPP. The incidence of incontinence after cryoprostatectomy was none. 3) There was no clear differences among the incidence of incontinence after prostatectomy and the weight of resected tissues. 4) There was no clear differences among various types of incontinence after each procedures of prostatectomies. 5) The incontinence was satisfactorily treated and disappeared in 18 patients within one year after the operation. In patients who failed to get continence within a year, the incontinence was likely to persist furthermore. 6) The cure rate was low in patients with abnormal findings in a cystometrogram performed prior to the operation. Associated diseases which could cause disorders in nervous system were frequently encountered in such patients. 7) Drugs and functional electrical stimulation (FES) were introduced for the treatment of incontinence after prostatectomy. FES was effective in 36.4 percent in which drug therapy was not effective. Since multiple drug regimen was administered in most of the patients, it was difficult to make a precise evaluation of judgement for effect of each of drugs.     

Analysis of risk factors for urinary incontinence after radical prostatectomy

INTRODUCTION: Our aim was to identify the independent risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: Using univariate and multivariate analyses, we examined several pre- and perioperative factors. One hundred and sixty-six patients were divided into three groups: patients who were immediately continent after catheter removal (group I), patients who became continent later (group II) and incontinent patients (group III). RESULTS: There were 34 patients (20.5%) in group I, 111 (66.9%) in group II, and 21 (12.6%) in group III. The multivariate analysis between the continent and incontinent patients proved that the postoperatively measured total length of the posterior urethra (strongly associated with length of the sphincter, length of the urethral stump and the presence of anastomotic stricture) was the independent risk factor for permanent incontinence or delayed continence following RRP. The age of patients per se represented a risk factor only for delayed continence, but not for permanent incontinence. CONCLUSIONS: Postoperatively measured shorter posterior urethral length results in an increased risk of urinary incontinence and delays continence after RRP. It seems that older age only delays reaching continence.     

Risk factors for duration of urinary incontinence after radical prostatectomy

PURPOSE: In this study, we examined risk factors for duration of incontinence after radical prostatectomy at our hospital. MATERIALS AND METHODS: From April 1988 to March 2000, 45 patients with prostate cancer underwent retropubic radical prostatectomy at our hospital. Thirty-eight of 45 patients could be followed up. The patients' age, height, weight, body mass index (BMI), preoperative prostatic specific antigen level, clinical stage, nerve-sparing surgery or none, operation time, bleeding volume, resected prostate weight, cancer positive or negative at surgical margins, postoperative stage, radiation therapy or none, anti-androgen therapy or none, duration of postoperative incontinence, and follow-up period were examined. RESULTS: All patients had postoperative stress incontinence, and no one had urge incontinence. Medians of duration of postoperative incontinence and follow-up period were 5.5 and 12 months, respectively. When the patients were divided into 2 groups by the value of each parameter, postoperative anti-androgen therapy (chi 2 test, p = 0.0429) and high BMI (> or = 25.0 kg/m2, p = 0.0206) were related to the long duration (> or = 5.5 months) of postoperative incontinence. CONCLUSION: These results suggest that common factors are involved in the etiology of prolonged incontinence after radical prostatectomy and genuine stress incontinence in women. Therefore, both body weight control and pelvic floor muscle exercise might be also important for the treatment of incontinence after radical prostatectomy.     

The impact of urinary extravasation after radical retropubic prostatectomy on urinary incontinence and anastomotic strictures.

OBJECTIVE: The aim of this study was to determine the relevance of urinary extravasation as proven by cystogram 18 days after radical retropubic prostatectomy for the degree of postoperative urinary incontinence and the incidence of anastomotic strictures. PATIENTS AND METHODS: A total of 225 patients underwent radical retropubic prostatectomy at our institution during a 30-month period, 215 of whom received a cystogram a mean 18 days following surgery. Three and 6 months after surgery these 215 patients were evaluated regarding the degree of urinary incontinence and the presence of anastomotic strictures. RESULTS: The cystogram demonstrated a watertight anastomosis in 89% (n = 195; group I), the remaining 11% (n = 24; group II) showed urine extravasation. Groups I and II were comparable with respect to age, preoperative serum levels of prostate-specific antigen (PSA), tumor grade and pathological staging. Six months after surgery, there was no statistically significant (p > 0.05) difference between both groups regarding the degree of urinary incontinence and the presence of anastomotic strictures. CONCLUSIONS: The presence of urine extravasation 18 days after radical retropubic prostatectomy has no impact on postoperative urinary incontinence and the incidence of anastomotic strictures. Based on these data it is not indicated to leave the catheter in situ beyond that point of time.     

Risk of urinary incontinence following radical prostatectomy

Of 143 prostatic cancer patients treated with radical prostatectomy 38 had undergone transurethral resection of the prostate before the prostatectomy. After radical prostatectomy 5 per cent of the patients who did not have a resection and 8.1 per cent of those who did were severely incontinent. This difference is not statistically significant.     

Managing urinary incontinence following radical prostatectomy.

New diagnoses of prostate cancer more than tripled between 1990 and 1996, largely because of improved methods of detection and heightened public awareness. Radical prostatectomy is often undertaken in men with prostate cancer who are expected to live at least 10 more years and have tumors confined to the prostate gland. Because of high 10-year survival rates, the demand for radical prostatectomy has increased steadily during the past decade and continues to climb as men pursue a cure and attempt to maximize survival. Survival benefits aside, however, radical prostatectomy carries a significant risk of urinary incontinence, which can dramatically impair quality of life. Despite medicine's steadfast pursuit of continence-preserving approaches to radical prostatectomy, nurses are currently challenged to provide care for a growing cohort of patients with postprostatectomy incontinence. This article reviews the clinical presentation and pathophysiology of postprostatectomy incontinence, including assessment and treatment options.