24例保留性神经的前列腺癌根治术后疗效观察

目的：探讨施行保留性神经的前列腺癌根治术后患者性功能及控尿情况的变化。方法：随访我院24例施行保留性神经前列腺癌根治术患者的性功能及控尿情况,并结合临床资料进行统计分析。结果：术后患者IIEF-5评分均不同程度降低,但仍有54．2％（13／24）的患者IIEF～5评分可达12分以上;术后勃起功能及控尿情况的恢复与患者年龄相关,年龄越低,恢复越好。结论：对于前列腺癌患者实行保留神经的前列腺癌根治术有助于患者术后性功能和控尿功能的恢复,尤其对于较年轻的患者效果更佳。     

比较两种保留神经的腹膜外腹腔镜前列腺癌根治术的疗效

目的比较筋膜间和筋膜内保留神经的腹腔镜前列腺癌根治术的治疗效果。方法选取开封市中心医院泌尿外科收治的前列腺癌患者86例,均接受保留神经的腹膜外腹腔镜前列腺癌根治术。随机分成2组,每组43例。对照组经筋膜间施术,观察组经筋膜内施术,比较2组的手术指标,术后6、12个月的勃起功能恢复情况及控尿功能。结果 2组手术时间、术中出血量、Gleason评分、尿管留置时间、术后住院时间及切缘阳性率比较,差异无统计学意义(P0.05)。术后6个月,观察组患者控尿功能显著优于对照组,差异有统计学意义(P0.05)。术后12个月,2组患者控尿功能差异无统计学意义(P0.05)。术后6、12个月,观察组患者总体勃起功能恢复率明显高于对照组,其中2组≤65岁患者差异有统计学意义(P0.05),但2组65岁患者差异无统计学意义(P0.05)。结论筋膜内和筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术的临床疗效相当,但筋膜内术式对术后勃起功能和控尿功能的恢复效果较好,尤其是年轻患者。     

前列腺癌根治术后电针联合提肛训练对改善尿控的研究

目的 探讨电针辅助提肛锻炼对前列腺癌根治术后患者尿失禁治疗的效果和意义.方法 2008年9月至2009年9月接受前列腺癌根治术并完整随访的患者109例,年龄48～79岁.按照术前患者意愿分为两组:治疗组40例,拔除导尿管1周后,在提肛锻炼的同时加用电针辅助治疗;对照组69例,术后只应用提肛锻炼帮助尿控恢复.随访术后尿控情况,记录相关临床特征,进行ICI-Q-SF量表评分,并进行相关统计学分析.结果 治疗组和对照组尿控曲线差异具有统计学意义(P=0.029).两组尿控率差异从术后4周起逐渐明显,至术后6周差异最大(P=0.023),其后差异逐渐缩小,至术后16周基本无差异.ICI-Q-SF评分量表显示的两组患者主观尿失禁感受也与尿控率情况相符合.结论 前列腺癌根治术后电针辅助提肛锻炼可以明显缩短患者尿控恢复时间.     

前列腺腹侧筋膜“堤坝样”保留法对前列腺根治术后勃起功能的影响

目的:探讨前列腺腹侧筋膜"堤坝样"保留法与经典保留性神经的前列腺癌根治术(NSRRP)对术后勃起功能的影响。方法:回顾性分析2012年1月~2015年12月我院54例局限性前列腺癌患者的临床资料,根据手术方式分为2组,行NSRRP,30例(A组),平均年龄为(61.2±8.6)岁;行前列腺腹侧筋膜"堤坝样"保留法联合NSRRP 24例(B组),平均年龄为(61.5±8.3)岁。2组患者术前血清前列腺特异性抗原(PSA)、术前勃起功能评分差异均无统计学意义(P0.05)。术后6个月国际勃起功能评分表(IIEF-5)问卷评估,比较2组患者术后勃起功能早期恢复情况。结果:2组平均术中出血量、术后平均拔除尿管时间差异均无统计学意义(P0.05)。2组拔除尿管后即刻控尿分别为12例和14例(40.0%vs.58.3%),6个月后控尿恢复分别为28例和23例(93.3%vs.95.8%),差异有统计学意义(P0.05)。6个月时,2组IIEF≥8分者分别为10例和16例(33.3%vs.66.7%),IIEF≥12分者分别为6例和10例(20.0%vs.41.7%),差异有统计学意义(P0.05)。结论:前列腺腹侧筋膜"堤坝样"保留法联合NSRRP,可提高前列腺癌根治术后患者勃起功能恢复率。     

低频电疗法联合盆底肌锻炼防治机器人辅助腹腔镜下前列腺癌根治术后尿失禁的疗效观察

目的:探讨低频电疗法联合盆底肌功能锻炼对行机器人辅助腹腔镜下前列腺癌根治术患者术后尿失禁(UI)的影响。方法:回顾性分析2017年1月～2018年6月在我院接受机器人辅助腹腔镜下前列腺癌根治术治疗的48例患者的临床资料,将予以常规护理的24例患者为对照组,在常规护理的基础上同时予以低频电子脉冲膀胱治疗仪联合盆底肌功能锻炼法辅助治疗的24例患者为观察组。结果:观察组患者术后早期UI的发生率明显低于对照组(37.5%vs.66.7%,P0.05),其恢复期3个月内尿控率明显高于对照组,差异有统计学意义(P0.05)。结论:对接受机器人辅助腹腔镜下前列腺癌根治术的患者行低频电疗法联合盆底肌功能锻炼可显著降低术后早期UI的发生率,提高恢复期控尿率,并可促进患者控尿功能的恢复。     

加速康复外科理念下针刺治疗腹腔镜下前列腺癌根治术后尿失禁的疗效观察

目的基于加速康复外科理念下观察针刺治疗腹腔镜下前列腺癌根治术后尿失禁的临床疗效。 方法将2018年1月至2019年11月青岛市市立医院收治的48例腹腔镜下前列腺癌根治术后尿失禁患者,分为试验组和对照组（每组24例）,试验组采用针刺联合盆底肌训练疗法,对照组采用盆底肌训练法。观察两组患者在治疗前后控尿的变化。 结果两组组内治疗前后相比1 h尿垫试验漏尿量（g）、ICIQ-SF评分、24 h尿失禁次数均有改善;试验组治疗后各项观察指标均显著低于对照组,总有效率、治愈率均显著高于对照组;两组未见明显不良反应。 结论针刺能够有效改善腹腔镜下前列腺癌根治术后患者尿失禁症状,促进尿控功能的恢复,符合加速外科康复理念,值得推广。     

小剂量伐地那非对阴茎手术后勃起功能恢复的研究

目的:探讨阴茎手术对勃起功能的影响并评估术后长期小剂量使用伐地那非对勃起功能的恢复作用。方法:选择阴茎手术患者共60例,随机分为两组:伐地那非治疗组和对照组,每组30例。治疗组术后5~7 d开始服用伐地那非10 mg,隔日1次,持续12周;对照组口服维生素E 100 mg,每日1次,持续12周。IIEF-5问卷评估术前和用药后3个月、6个月勃起功能改变。结果:治疗组术前IIEF-5评分为(14.21±3.62)分,术后3、6个月IIEF-5评分[(18.83±2.98)分,(20.13±2.98)分]较手术前提高,差异均有显著性(P均<0.05);而对照组患者术后3个月勃起功能下降,IIEF-5评分(13.38±2.82)分较术前(15.80±3.02)分降低,差异有显著性(P>0.05)。治疗组术后IIEF-5评分较对照组高(P<0.05)。结论:阴茎手术后小剂量长期服用伐地那非有助于恢复和保持阴茎的勃起功能。     

综合护理干预对前列腺癌根治术后尿失禁影响的研究

目的 探讨综合护理干预措施对前列腺癌根治术后尿失禁的影响.方法 将25 例前列腺癌根治术后尿失禁的患者随机分为常规护理组(对照组)和综合护理组(观察组),观察组在常规护理的基础上,采取盆底肌训练、排尿反射训练、膀胱功能训练、盆底电刺激及生物反馈治疗等一系列的护理干预措施,观察两组患者于尿管拔除后半年内的尿失禁恢复情况.结果 观察组尿失禁的恢复时间比对照组明显缩短,护理干预效果的有效率高于对照组.两组比较,差异显著,有统计意义.结论 对前列腺癌根治术后尿失禁的患者,应采取综合护理干预措施,改善尿失禁情况,使患者早日恢复控尿功能,提高患者的生活质量.     

心理治疗对前列腺电汽化术后勃起功能恢复的价值

目的探讨心理治疗对前列腺电汽化术后勃起功能恢复的作用。方法共183例患者，其中治疗组81例，对照组102例，通过问卷调查的方式，用勃起功能国际问卷-5（IIEF-5）对TUVP患者心理治疗组以及对照组术前、术后（3、6、12月）阴茎勃起功能情况进行评分。结果随访1年，两组患者手术前后IIEF-5评分均有明显下降，治疗组由术前平均14．7分降至11．8分（P〈0．05），对照组由术前平均15．1分降至8．5分（P〈0．05），虽然术后3月曲组间的IIEF-5评分没有差异性，但是在术后6月及12月治疗组患者阴茎勃起功能恢复状况明显高于对照组（P〈0．05）。结论前列腺电汽化术后勃起功能的下降是多因素引起的，但通过对患者的心理治疗与心理调节对手术后阴茎勃起功能恢复有积极的促进作用。     

早期康复训练在预防腹腔镜前列腺癌根治术后尿失禁的应用研究

目的 探讨早期康复训练对预防腹腔镜前列腺癌根治术后尿失禁的应用效果.方法 将100例拟行腹腔镜前列腺癌根治术患者随机分成观察组和对照组各50例,观察组实施早期康复训练,术前及术后早期均进行提肛训练;对照组实施常规护理,仅在术后进行提肛训练.比较两组患者术后拔除尿管后尿失禁发生率、尿控功能恢复时间以及观察组术前不同提肛训练时间与术后尿失禁发生率的关系.结果 观察组术后尿失禁发生率、尿控功能恢复时间均明显低于对照组(P＜0.05);不同术前提肛训练时间尿失禁发生率比较差异无统计学意义(P＞0.05).结论 早期康复训练有助于预防腹腔前列腺癌根治术后尿失禁的发生,缩短尿控功能恢复时间.     

Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.     

Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence

The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients’ urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.     

Seminal monolateral nerve-sparing radical prostatectomy in selected patients

INTRODUCTION: In recent years there has been a shift in prostate cancer stage with the majority of patients nowadays being operated with cT1c disease, prostate-specific antigen levels of <10 ng/ml, and a decreased rate of seminal vesicle invasion. Recent data suggest the role of preservation of the seminal vesicle in improving continence and/or potency. We describe our preliminary experience with seminal-sparing, unilateral nerve-sparing retropubic radical prostatectomy. PATIENTS AND METHODS: 21 selected patients with clinically localized prostate cancer underwent seminal unilateral nerve-sparing retropubic radical prostatectomy (seminal-sparing group, SSG). We compared the postoperative continence, erectile function and quality of orgasm results to those obtained in a control group (CG) of 21 patients who underwent unilateral nerve-sparing radical prostatectomy. Sexual function was evaluated preoperatively and 9 months postoperatively with the 5-item International Index of Erectile Function (IIEF-5) questionnaire and with other self-administered questionnaires. The quality of orgasm was evaluated 9 months postoperatively. RESULTS: 1 month postoperatively, 95 and 28% of the patients in the SSG and CG were continent (p<0.001). The median postoperative drop in IIEF-5 score was 5 points in SSG and 14.5 points in CG (p<0.0001). Nine months postoperatively, 90 and 62% of the patients in SSG and CG, respectively (p=0.05), maintained the ability to achieve orgasm. CONCLUSIONS: In our experience seminal-sparing radical prostatectomy showed good feasibility and improved early postoperative urinary continence, erectile function and quality of orgasm, without compromised cancer control.     

Does Physiotherapist-Guided Pelvic Floor Muscle Training Reduce Urinary Incontinence After Radical Prostatectomy? : A Randomised Controlled Trial

BACKGROUND: Urinary incontinence after radical prostatectomy (RP) is a common problem and may lead to reduced quality of life. OBJECTIVE: To assess the effects of guided pelvic floor muscle training on continence status and perceived problems with urinary function after RP. DESIGN, SETTING, AND PARTICIPANTS: We conducted a randomised controlled trial at St. Olavs Hospital/Trondheim University Hospital in Norway between September 2005 and December 2007. All men with clinically localised prostate cancer who underwent surgery with open RP were invited to participate, until 85 participants were included. Dropout rate was 6%. INTERVENTION: Two intervention groups (A and B). Both groups received instructions in correct pelvic floor muscle contractions and were encouraged to train the pelvic floor muscles. Group A was offered additional follow-up training instructions by a physiotherapist throughout the 1-yr period. MEASUREMENTS: Primary outcome was continence (0 pads) status, and secondary outcomes were perceived problems with urinary function 6 wk and 3, 6, and 12 mo postoperatively. RESULTS: No statistically significant difference in continence status between groups was found at 3 mo; 46% were continent in group A versus 43% in group B (p=0.73). In group A, 97% reported no or only mild problems with urinary function compared to 78% in group B (p=0.010). After 6 mo there was a clinically relevant difference in continence status between groups: 79% were continent in group A and 58% in group B (p=0.061). Twelve months postsurgery the difference was clinically and statistically significant (p=0.028) in favour of group A; 92% were continent in group A and 72% in group B. CONCLUSIONS: Continence rates were similar 3 mo after RP in groups performing intensive pelvic floor muscle training with or without follow-up instructions by a physiotherapist. However, in the following period up to 1 yr, the group receiving physiotherapist-guided training reduced urinary incontinence significantly more compared to patients training on their own.     

Early post-prostatectomy pelvic floor biofeedback

PURPOSE: We determined whether biofeedback enhanced pelvic floor exercises begun 6 weeks after radical prostatectomy improve the early recovery of continence. MATERIALS AND METHODS: We randomized 30 patients who underwent radical retropubic prostatectomy into a group that received 5 biofeedback sessions and a control group. RESULTS: Overall 87% of patients were pad-free at 6 months with similar results in the treatment and control groups (86% versus 88%). There was no statistically significant difference in pad test results or voiding diary records in the 2 groups. CONCLUSIONS: A treatment program of biofeedback enhanced pelvic floor exercises begun 6 weeks after radical retropubic prostatectomy did not significantly affect continence in this study.     

盆底筋膜保护与重建对腹腔镜下前列腺癌根治术后早期控尿的影响

目的：了解采用盆底筋膜保护与重建法对腹腔镜下前列腺癌根治术后患者早期控尿的影响.方法回顾性分析自同一术者2013年1月至2015年12月在广东省中医院泌尿外科行腹腔镜下前列腺癌根治术的40例患者资料,其中采用盆底筋膜保护与重建技术的前列腺癌患者17例(治疗组),采用常规腹腔镜下治疗的前列腺癌患者23例(对照组),对两组患者的年龄、术前BMI、术前前列腺体积、术前临床分期、术前 Gleason 评分、手术时间、术中出血量、术后吻合口漏尿率、术后病理切缘阳性率、术后病理分期、术后 Gleason 评分及早期尿控功能恢复的情况等临床指标进行统计学分析.结果40例腹腔镜下前列腺癌根治术均经腹膜外完成,术中无中转开放,无术中输血病例,术后吻合口无漏尿,两组均有1例术后病理切缘阳性.两组在年龄、术前 BMI、术前前列腺体积、术前临床分期、术前 Gleason 评分、手术时间、术中出血量、术后病理分期及术后 Gleason评分方面差异均无统计学意义(P ＞0．05);40例患者均在术后12~16 d 拔除尿管,治疗组拔除尿管后3 d 内、1个月内和3个月内的累积完全控尿比例分别为52．9％、64．7％和82．4％,显著高于对照组(分别为8．7％、26．1％和34．8％),两组差异有统计学意义(P ＜0．05).结论在腹腔镜前列腺癌根治术中使用盆底筋膜保护与重建技术可显著提高患者术后早期的控尿能力.     

A systematic review of PFE pre-prostatectomy

Male Stress Urinary Incontinence is a complication post robotic radical prostatectomy. This is a major problem that needs to be solved, since it has great impact on quality of life affecting the patient’s physical activity and social well-being. A systematic review relating to literature on impact of preoperative PFE on continence outcomes for patients undergoing prostatectomy was conducted. The search strategy aimed to identify all references related to pelvic floor exercises and post-prostatectomy. Search terms used were as follows: (Pelvic floor exercises) AND (incontinence) AND (prostatectomy). The following databases were screened from 2000 to September 2017: CINAHL, MEDLINE (NHS Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, Web of Science. In addition, searches using Medical Subject Headings (MeSH) and keywords were conducted using Cochrane databases. Two UK-based experts in prostate cancer and robotic surgery were consulted to identify any additional studies. In the 6 months following surgery, the continence rates, as defined by the use of one pad or less per day, were 94% (44 of 47) and 96% (48 of 50) in the PFE and biofeedback groups and control groups (PFE alone), respectively (P?=?0.596) (Bales et al. in Urology 56: 627–630, 2000). This demonstrates preoperative PFE may improve early continence after RP. Geraerts et al. (Eur Urol 64:766–772, 2013) demonstrated the “incontinence impact” was in favour of a group with PFE at 3 and 6 months after surgery. This demonstrates again the advantage of preoperative PFE. Cornel et al. [World J Urol 23:353–355, 2005] determined the benefit of starting pelvic floor muscle exercise (PFE) 30 days before RP and of continuing PFE postoperatively for early recovery of continence as part of a randomised, prospective study (Moher quality A). This demonstrated preoperative PFE may improve early continence and QoL outcomes after RP. Post-prostatectomy incontinence is a bothersome complication of radical prostatectomy [Chughtai et al. in Rev Urol 15:61–66, 2013]. Weak pelvic floor muscles compromised normal pelvic floor function and led to urinary incontinence and erectile dysfunction. Strengthening the pelvic floor muscles was shown to significantly improve post-prostatectomy urinary continence, post-micturition dribble and erectile function. It would be prudent for all men to exercise their pelvic floor muscles to maintain normal pelvic floor function and start prior to surgery.     

Seminal vesicle-sparing radical prostatectomy: a novel concept to restore early urinary continence

OBJECTIVES: Urinary incontinence after radical prostatectomy continues to be a distressing problem, even with preservation of the neurovascular bundles and meticulous apical dissection. Recent studies suggest that motor and sensory components of the pelvic nerve may be affected by surgery, since both components are anatomically located in intimate contact with the seminal vesicles. We propose seminal vesicle-sparing radical prostatectomy to preserve pelvic innervation and improve the rate of urinary continence. METHODS: Fifty-four patients were enrolled in this prospective study. A standard retropubic radical prostatectomy was performed in 34 patients. A seminal vesicle-sparing radical prostatectomy was performed in a pilot series of 20 consecutive patients. The seminal vesicle tip and surrounding tissue were preserved and carefully handled. In all patients, a modified pad test and posterior urethral sensory threshold test were performed preoperatively and 6 weeks and 6 months postoperatively and correlated with urinary continence. RESULTS: The intraoperative preservation of the seminal vesicle tip was possible in all patients in this pilot series (n = 20). In the seminal vesicle-sparing radical prostatectomy group, the continence rate was 60% after 6 weeks and 95% after 6 months. These rates were significantly higher than the continence rates in the standard prostatectomy group (18% and 82% at 6 weeks and 6 months, respectively). The sensory threshold levels in the seminal vesicle-sparing group were similar to the preoperative values and were significantly lower than the postoperative threshold levels in the standard prostatectomy group. CONCLUSIONS: Seminal vesicle tip-sparing radical prostatectomy may be a surgical option to preserve pelvic innervation and maintain urinary continence after radical prostatectomy. Further randomized studies are necessary to elucidate the impact of seminal vesicle-sparing radical prostatectomy on restoration of urinary continence.