腹腔镜根治性前列腺切除术中尿控功能保护的方法和手术技巧

目的探讨腹腔镜根治性前列腺切除术中尿控功能的保护,预防术后尿失禁的手术方法及技巧。方法对2008年10月至2012年6月施行的81例腹腔镜前列腺癌根治术资料进行回顾性研究。81例TNM分期为T1C～T2C的前列腺癌患者行腹腔镜前列腺癌根治术,其中经腹膜外径路15例,经腹腔途径66例。术中注重以下策略：①可靠处理背血管复合体;②尽量保留神经血管束,对部分低危患者施行筋膜内根治性前列腺切除术;③保留足够的功能性尿道;④黏膜对黏膜无张力吻合。所有患者于术后1、3、6和12个月随访尿控情况。结果术后留置导尿管7～23d。所有患者均随访满6个月,77例患者随访满12个月。术后6个月,白天62例（76．5％）患者尿控良好,尿失禁19例;夜间68例（84．0％）患者尿控良好,尿失禁13例。术后12个月,白天70例（90．9％）患者尿控良好,尿失禁7例;夜间74例（96．1％）患者尿控良好,仍有尿失禁3例。筋膜内根治性前列腺切除术5例,术后7～11d拔除导尿管后,仅1例白天有尿失禁,随访至术后3个月,已无一例存在尿失禁。随访期间无一例出现尿道狭窄。结论腹腔镜根治性前列腺切除术后的尿控功能恢复是渐进式的,绝大多数患者在术后12个月恢复尿控能力。术野清晰,努力做到解剖性前列腺切除,保留尽可能多的功能性尿道长度,黏膜对黏膜无张力吻合（避免术后尿道狭窄）,将膜部尿道缝合至趾骨后就能获得良好的尿控效果。对低危的前列腺癌患者施行筋膜内根治性前列腺切除术将能获得最佳尿控结果。     

腹腔镜前列腺癌根治术治疗高危前列腺癌的临床体会

目的：探讨腹腔镜前列腺癌根治术在高危前列腺癌治疗中的价值。方法回顾性分析2012年3月～2014年11月本院腹腔镜前列腺癌根治术治疗26例高危前列腺癌的临床资料。患者平均年龄65．2岁,术前检查单独PSA≥20ng／mL者9例;兼具PSA≥20ng／mL并Gleason评分≥8分者17例;术前诊断T3 b和T4期各1例。3例患者因前列腺体积过大术前分别行3～6个月新辅助内分泌治疗。手术方式均采用经腹膜外路径腹腔镜前列腺癌根治术,同时行盆腔淋巴结清扫。结果26例手术均获成功,平均手术时间152min,平均出血量85mL,无输血病例。所有患者均于术后两周拔除导尿管,8例拔管后尿失禁,经盆底训练后于1周至3个月恢复控尿。术后病理T2a～T2b,Gleason评分≤7分者10例;T2c～T4,Gleason评分≥8分者16例。术中清扫淋巴结数目平均5．5个,淋巴结阳性3例;切缘阳性4例,术后控尿恢复后予局部放射治疗。19例获访3～30个月,所有患者均控尿良好,PSA≤0．2ng／mL。结论对高危前列腺癌患者采用以根治性前列腺癌切除术为核心的综合治疗策略安全有效,可使患者获益。     

经腹膜外途径腹腔镜前列腺癌根治术中尿控技巧探讨

目的回顾性总结探讨经腹膜外途径腹腔镜下前列腺癌根治术中处理尿控的方法及技巧。方法临床选择T1～T3a前列腺癌患者44例,年龄为58～82岁,平均年龄为70.5岁。术前前列腺总特异性抗原(TPSA)为8.9～38.6 ng/ml。所有患者术前均行经直肠前列腺穿刺活检,病理明确诊断证实为前列腺癌,平均Gleason评分(5.6±2.5)分,44例患者均行经腹膜外途径腹腔镜下前列腺癌根治术。结果 44例患者均顺利完成手术,手术时间150～410分钟,平均手术时间(220±85)分钟;术中出血量300～1500ml,平均(400±220)ml;术后完全尿控33例(75.0%),部分尿控9例(20.5%)(1周后恢复),完全性尿失禁2例(4.5%)(持续3个月以上),术后病理切缘阳性6例(13.6%);直肠损伤1例,经保守治疗治愈。结论腹腔镜下前列腺癌根治术治疗局限性前列腺癌安全、有效,术后尿控效果与术中神经血管束(NVB)、远端尿道保留长度、正确处理膀胱颈部、膀胱尿道吻合的技巧处理及术者的经验相关。     

保留尿控功能在耻骨后前列腺癌根治术的应用

目的:探讨保护耻骨前列腺韧带和保护尿道膜部括约肌群在耻骨后前列腺癌根治术后减少尿失禁的作用.方法:Ⅰ组32例前列腺癌按常规操作行耻骨后前列腺癌根治术,Ⅱ组32例前列腺癌采用保留耻骨前列腺韧带和尿道膜部括约肌群的方法行耻骨后前列腺癌根治术,术后1、3、6、12个月分别随访尿失禁情况.结果:两组年龄和PSA无显著差异,两组前列腺尖端切缘均无肿瘤残留,前列腺侧缘阳性率类似.Ⅱ组术后1、3、6个月尿控效果明显优于I组(P<0.05),但1年随访,Ⅰ组和Ⅱ组尿控效果类似.结论:在耻骨后前列腺癌根治术中保留耻骨前列腺韧带作用和尿道膜部括约肌群有显著提高近期尿控的效果,但1年随访两组尿控率无明显差异.     

腹腔镜前列腺癌根治术中保留神经血管束的疗效观察（附17例报告）

目的评价腹腔镜下前列腺癌根治术(LRP)中保留神经血管束(NVB)的临床意义。方法2005年8月—2008年3月,对17例局限性前列腺癌患者行LRP,术前临床分期T1b3例,T1c8例,T2b2例,T2c3例,T3a1例。术中采用保护尿道膜部括约肌和双侧前列腺旁神经血管束,重建膀胱颈部充分外翻后,间断、无张力行膀胱颈尿道吻合。结果17例手术均获成功,无一例中转开放。手术平均时间290min(190～370min),出血量平均360ml(200～640ml)。其中2例术中因处理阴茎背血管复合体(DVC)不当出现较大出血,分别为600ml和640ml,均未输血。术后随访6～37个月,全部患者排尿通畅,无肿瘤复发。14例术后6个月内恢复尿控能力,2例在术后9个月内恢复,1例术后12个月后尚存在轻度尿失禁。14例患者在术后12月内可以充分或部分勃起,3例不能勃起。结论LRP中保留双侧NVB,保护尿道膜部括约肌,能有效减少根治术后患者尿失禁及勃起障碍的发生。     

经尿道前列腺电切术术后前列腺偶发癌腹腔镜下前列腺癌根治术临床观察

目的:探讨经尿道前列腺电切(TURP)术后发现前列腺偶发癌行腹腔镜下前列腺癌根治术的经验。方法:2005年4月至2011年12月收治既往行TURP术后发现前列腺癌的患者4例,免疫组化提示p504s阳性,3例在TURP术后3个月行腹腔镜下前列腺癌根治术,1例患者术后1.5月行腹腔镜下前列腺癌根治术。结果:4例手术顺利完成,均为经腹膜外途径。术后病理前列腺腺癌2例,Gleason评分为6～7分,1例报告为高级别上皮瘤变,1例未见癌。术后4例患者控尿功能好。随访1～79个月,4例患者无明显尿失禁,无转移表现,未出现ED现象。结论:在腹腔镜技术熟练的条件下,TURP术后前列腺偶发癌行腹腔镜下前列腺癌根治术疗效满意。     

前列腺增生症术后行前列腺癌根治术的临床观察

目的：总结前列腺增生症术后行耻骨后前列腺癌根治手术的体会。方法：对11例经尿道前列腺电切、2例经耻骨上前列腺切除术后病理检查证实为前列腺癌的患者行耻骨后前列腺癌根治术，患者平均年龄65岁，TNM分期为T1a-b 4例，T1c 8例，T2b 1例。结果：13例平均随访2年，全部无瘤存活，1例发生尿道狭窄，1例发生轻度尿失禁，最大尿流率15～32ml／min，3例恢复性功能。结论：前列腺增生症术后前列腺尖部有一定程度粘连，在耻骨后前列腺癌根治术中，通过仔细解剖，采用保护耻骨前列腺韧带和膜部括约肌的方法，同样可获得满意的尿控效果。     

最长尿道长度保存对腹腔镜前列腺癌根治术后尽快恢复尿控的意义研究

目的:研究最长尿道长度保存(maximal urethral length preservation,MULP)对腹腔镜前列腺癌根治术后尽快恢复尿控的临床意义。方法:回顾性分析我院2013年2月~2015年3月80例行腹腔镜前列腺癌根治术的临床资料,随访至2016年3月。其中40例进行MULP腹腔镜前列腺癌根治术患者为治疗组,另外40例非行MULP腹腔镜前列腺癌根治术患者为对照组,在手术前两组患者年龄、平均BMI、既往史(糖尿病)、术前NHT、前列腺体积、术前前列腺特异性抗原(PSA)、术前Gleason评分、术前病理T分期均无统计学意义(P0.05)。比较治疗组与对照组手术时间、切缘阳性率、前列腺尖部切缘阳性率、术后PSA(ng/ml)、术后Gleason评分、并发症率及两组患者术后1、3、6、12个月尿控恢复情况、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-QSF)评分情况。结果:两组患者手术都成功完成,两组术后3、6、12个月并发症发生率、切缘阳性率、前列腺尖部切缘阳性率及PSA0.2ng/ml的比率差异均无统计学意义(P0.05)。两组术后1、3个月尿控恢复人数和ICIQ-SF评分情况差异均有统计学意义(P0.05);术后6、12个月的尿控恢复人数和ICI-Q-SF评分情况差异均无统计学意义(P0.05)。结论:行MULP的腹腔镜前列腺癌根治术有利于术后早期尽快恢复尿控,且不增加切缘阳性率。     

腹腔镜筋膜内前列腺癌根治性切除术对尿控恢复的影响及相关因素分析

目的:通过总结我院腹腔镜筋膜内前列腺癌根治性切除术的方法及患者术后尿控恢复的随访记录,对影响尿控恢复的相关因素进行分析。方法:2009年9月至2012年11月共为128例患者行腹腔镜筋膜内前列腺癌根治性切除术,患者43~78岁,平均(57.0±11.4)岁,术前血PSA 4.1~18.8 ng/ml,平均(9.9±6.1)ng/ml;临床分期T185例、T243例;活检组织Gleason评分:5分13例、6分38例、7分77例,术中不打开盆底筋膜,自膀胱颈口1点及11点位置纵行切开前列腺筋膜,紧贴前列腺包膜分离前列腺前面、两侧、尖部,最大限度保留盆底神经及肌肉组织,术后随访患者尿控变化12个月。结果:128例手术均顺利完成,无中转筋膜外前列腺癌根治性切除术,手术时间45~118 min,平均(84.0±24.6)min;术中出血量15~220 ml,平均(140.0±52.1)ml;无输血,留置尿管7~15 d,平均(11.0±3.8)d。术后随访12个月,完全尿控96例(75.0%),轻微尿失禁28例(21.9%),中度尿失禁4例(3.1%),无重度及完全尿失禁病例。结论:腹腔镜筋膜内前列腺癌根治性切除术最大限度地保留了盆底肌肉、神经组织,使术后尿控得到更好的恢复,值得推广应用。     

保留控尿功能的腹腔镜前列腺癌根治术

目的 探讨保护控尿功能的前列腺癌根治术的技术要点.方法 对收治的94例T1b～T2c前列腺癌患者行保留控尿功能的前列腺癌根治术,即腹腔镜下精细解剖前列腺尖部,保护EUS及其控尿神经,膀胱颈后唇成形后与尿道吻合;并同前期42例行常规前列腺癌根治术(LRP)的患者比较,术后30、60和90 d评估患者的控尿状况.控尿标准: 站立或行走时无尿液漏出,或全天使用尿垫不超过1块.结果 术后30、60 d控尿率LRP组为27.7%(13/47)、66.0%(31/47);CSLRP组为55.3%(26/47)、85.1%(40/47),均有统计学差异(χ2＝7.406,4.663,P<0.05).术后90 d两组控尿率为78.7%(37/47)和91.5%(43/47)(χ2＝3.02,P>0.05).结论 利用腹腔镜的优点,保护EUS和膀胱颈后唇成形加强尿道后壁,能明显加快前列腺癌根治术后控尿的恢复时间.     

Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy

ObjectiveThis study investigated the urinary incontinence status and urodynamic changes of localized prostate cancer patients after laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RaRP).Materials and methodsWe enrolled 36 and 30 patients who underwent LRP and RaRP, respectively. The urinary incontinence status and videourodynamic studies (VUDS) of the LRP and RaRP groups during the first year after the surgery were compared.ResultsThe RaRP group was younger and had a smaller prostate volume, shorter operation time, less blood loss, and higher proportion of patients who received postoperative radiotherapy than the LRP group. Twenty RaRP and 26 LRP patients completed VUDS during the 1-year follow-up. Overall, reduced detrusor voiding pressure (Pdet), increased maximal urinary flow rate (Qmax), and reduced bladder outlet obstruction index (BOOI) were detected at 3, 6, and 12 months postoperatively. At 12 months, both the LRP and RaRP groups had similar significant reductions of Pdet. However, only the RaRP group had a significant increase of Qmax and significant reduction of BOOI. Overall, 56.5% of patients (26 of 46) had detrusor overactivity (DO) before the surgery. The de novo DO rate and DO remission rate were 15.2% and 19.6%, respectively, without significant difference between the LRP and RaRP groups. At 6 months, the RaRP group had a significantly lower rate of stress urinary incontinence (SUI) than the LRP group (4.5% versus 47.2%, p = 0.003). In the RaRP group, the greater degree of recovery of both stress and urgency urinary continence developed during the first 6 months postoperatively.ConclusionThe changes of VUDS at 12 months postoperatively for radical prostatectomy included reduced Pdet and BOOI, and increased Qmax. At 6 months, the RaRP group had a lower SUI rate then the LRP group. The key phase of urinary continence recovery was the first 6 months after the surgery.     

Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

Context

Robot-assisted radical prostatectomy (RARP) was proposed to improve functional outcomes in comparison with retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). In the initial RARP series, 12-mo urinary continence recovery rates ranged from 84% to 97%. However, the few available studies comparing RARP with RRP or LRP published before 2008 did not permit any definitive conclusions about the superiority of any one of these techniques in terms of urinary continence recovery.

Objective

The aims of this systematic review were (1) to evaluate the prevalence and risk factors for urinary incontinence after RARP, (2) to identify surgical techniques able to improve urinary continence recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP in terms of the urinary continence recovery rate.

Evidence acquisition

A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. The Medline search included only a free-text protocol using the term radical prostatectomy across the title and abstract fields of the records. The following limits were used: humans; gender (male); and publication date from January 1, 2008. Searches of the Embase and Web of Science databases used the same free-text protocol, keywords, and search period. Only comparative studies or clinical series including >100 cases reporting urinary continence outcomes were included in this review. Cumulative analysis was conducted using the Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK).

Evidence synthesis

We analyzed 51 articles reporting urinary continence rates after RARP: 17 case series, 17 studies comparing different techniques in the context of RARP, 9 studies comparing RARP with RRP, and 8 studies comparing RARP with LRP. The 12-mo urinary incontinence rates ranged from 4% to 31%, with a mean value of 16% using a no pad definition. Considering a no pad or safety pad definition, the incidence ranged from 8% to 11%, with a mean value of 9%. Age, body mass index, comorbidity index, lower urinary tract symptoms, and prostate volume were the most relevant preoperative predictors of urinary incontinence after RARP. Only a few comparative studies evaluated the impact of different surgical techniques on urinary continence recovery after RARP. Posterior musculofascial reconstruction with or without anterior reconstruction was associated with a small advantage in urinary continence recovery 1 mo after RARP. Only complete reconstruction was associated with a significant advantage in urinary continence 3 mo after RARP (odds ratio [OR]: 0.76; p = 0.04).Cumulative analyses showed a better 12-mo urinary continence recovery after RARP in comparison with RRP (OR: 1.53; p = 0.03) or LRP (OR: 2.39; p = 0.006).

Conclusions

The prevalence of urinary incontinence after RARP is influenced by preoperative patient characteristics, surgeon experience, surgical technique, and methods used to collect and report data. Posterior musculofascial reconstruction seems to offer a slight advantage in terms of 1-mo urinary continence recovery. Update of a previous systematic review of literature shows, for the first time, a statistically significant advantage in favor of RARP in comparison with both RRP and LRP in terms of 12-mo urinary continence recovery.     

Urinary continence after radical prostatectomy: Predictive factors of recovery after 1 year of surgery

Objectives: To evaluate the clinical prognosis of incontinence and to determine the predictors for further recovery of urinary continence in patients not achieving urinary continence within 1 year after radical prostatectomy. Methods: A total of 708 patients were evaluated regarding urinary continence status at 1 year after surgery from a prospectively maintained radical prostatectomy database. Of these, 73 (10.3%) did not recover urinary continence within 1 year after surgery. For these patients, incontinence status and the number of pads for urinary control were assessed serially. Results: In 708 patients, factors associated with the recovery of urinary continence within 1 year after radical prostatectomy were membranous urethral length, prostatic apex shape and patient age. Among 73 patients with urinary incontinence, 41 (56.2%) achieved urinary continence with a mean time of 15.4 months subsequent to the first year after radical prostatectomy (baseline). A younger age at surgery (P = 0.027) and one pad being required (vs≥2 pads) at baseline (P = 0.046) were identified as independent factors for achievement of urinary continence within a further 2 years. Only the number of pads was a significant factor for further recovery of urinary continence in the longer follow up (hazard ratio 0.36, P = 0.029). Conclusion: Compared with factors related to the prostate or membranous urethra, patient age and severity of incontinence at 1 year after radical prostatectomy are more strongly related to the recovery of urinary continence later than 1 year after surgery. These findings might help to decide whether a definite treatment is required for persistent incontinence beyond 1 year after radical prostatectomy.     

Radical retropubic prostatectomy reduces symptom scores and improves quality of life in men with moderate and severe lower urinary tract symptoms

PURPOSE: We determine the impact of radical retropubic prostatectomy on lower urinary tract symptoms and quality of life due to urinary problems in men with clinically localized prostate cancer. MATERIALS AND METHODS: The American Urological Association (AUA) symptom index, a symptom problem index and a quality of life due to urinary problems question were administered to 104 men before and 12 months after radical prostatectomy. Urinary continence and satisfaction with the decision to undergo radical prostatectomy were also examined. RESULTS: In men with moderate or severe baseline urinary symptoms (AUA score 8 or greater) the total AUA symptom, symptom problem and quality of life question scores decreased by 51 (-6.39), 57 (-4.22) and 25% (-0.65), respectively, after radical prostatectomy. Except for nocturia statistically significant improvements were observed for all questions captured by the AUA symptom index. Radical prostatectomy did not significantly change mean AUA symptom score or symptom problem index in men with mild urinary symptoms (AUA score less than 8). In men with moderate or severe urinary symptoms radical prostatectomy significantly improved quality of life due to urinary problems. Although 10% of men exhibited some degree of clinically relevant stress incontinence, 98% were very satisfied or satisfied with the decision to undergo radical prostatectomy. CONCLUSIONS: In men with moderate or severe urinary symptoms radical prostatectomy improves lower urinary tract symptoms and quality of life due to urinary problems. The overall beneficial impact on voiding makes radical prostatectomy an attractive treatment option for clinically localized prostate cancer.     

系统评价机器人辅助腹腔镜与单纯腹腔镜前列腺癌根治术后的控尿功能

目的:评价机器人辅助前列腺癌根治术(robot-assisted laparoscopic prostatectomy,RALP)与单纯腹腔镜前列腺癌根治术(pure laparoscopic radical prostatecomy,LRP)的术后控尿功能。方法:检索PubMed、Web of Science、Cochrane图书馆、CNKI、维普数据库及万方数据库关于RALP和LRP治疗局限性前列腺癌的比较性研究文献,按Cochrane操作员手册筛选文献、提取资料并评价质量后,采用RevMan5.2版本软件进行数据处理分析。结果:系统评价纳入2篇随机对照试验,7篇非随机对照试验,共1 950例患者,其中RALP治疗1 098例,LRP治疗852例。RALP相比LRP术后控尿率,1个月比值比(odds ratio,OR)=2.28,95%可信区间(confidence interval,CI)为(1.68,3.08),3个月OR=1.51,95%CI为(1.21,1.88),6个月OR=1.97,95%CI为(1.44,2.70),12个月OR=1.53,95%CI为(1.11,2.11),两者术后控尿功能差异有统计学意义(P0.05)。结论:在治疗局限性前列腺癌方面,RALP可能术后控尿功能更优。     

经腹膜外途径腹腔镜前列腺癌根治术23例观察

目的探讨经腹膜外途径腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)治疗局限性前列腺癌的手术方法和临床疗效。方法回顾性分析23例前列腺癌患者行经腹膜外途径腹腔镜前列腺癌根治术的临床资料。23例患者病理诊断均为前列腺癌,TNM分期T1N0M0 9例,T2N0M0 14例,Gleason评分均≤7分。结果 23例手术均获得成功,无中转开放手术。手术时间105³00 min,平均150 min;术中出血量120300 min,平均150 min;术中出血量120⁸00 mL,平均240 mL。术后留置尿管时间16800 mL,平均240 mL。术后留置尿管时间16²2 d,平均18 d。3例出现轻度尿失禁,经提肛等辅助治疗,3个月后无真性尿失禁发生。术后病理报告示标本切缘阳性1例,术后行全激素阻断治疗3个月。术后前列腺特异性抗原(prostate specific antigen,P S A)均<4.0 ng/mL。1例因其他原因死亡。术后随访322 d,平均18 d。3例出现轻度尿失禁,经提肛等辅助治疗,3个月后无真性尿失禁发生。术后病理报告示标本切缘阳性1例,术后行全激素阻断治疗3个月。术后前列腺特异性抗原(prostate specific antigen,P S A)均<4.0 ng/mL。1例因其他原因死亡。术后随访3¹2个月,无生化复发。结论经腹膜外腹腔镜前列腺癌根治术具有创伤小,出血少,恢复快,并发症少等优点,是一种安全可行的手术方式,值得临床推广。     

控尿技术在腹腔镜前列腺癌根治术中的应用

目的　探讨腹腔镜改良前列腺癌根治术 (LRP)治疗早期前列腺癌的疗效。　方法　2000年 10月至 2004年 9月,对 54例TNM分期为T1b~T2 的前列腺癌患者行经腹途径LRP。前期 15例(A组)按Monstouris法完成手术;后期 39例(B组)在熟悉LRP基本技术后进行技术改良:结扎耻骨后血管复合体,沿前列腺包膜锐性分离前列腺尖部,保留尿道括约肌和尿道直肠肌; 正确判断前列腺与膀胱颈交界部,保护膀胱颈环状肌环;横行离断膀胱颈后唇,在狄氏筋膜和膀胱肌外层之间向膀胱颈近端方向适当游离膀胱颈后唇;精细吻合后尿道与膀胱颈,将吻合口的前壁与耻骨后血管复合体固定。比较两组手术时间、出血量、围手术期并发症、术后控尿恢复时间和血清前列腺特异性抗原(PSA)值。　结果　54例手术均获成功。A、B两组平均手术时间分别为 390(270 ~660)min和 240(180~360)min; 平均出血量 430 ( 200 ~1100 )ml和 160 ( 100 ~400 )ml;手术并发症分别为 6例和5例;恢复控尿时间分别为 6个月和 3个月。以上指标两组比较差异均有统计学意义(P<0. 05)。血清前列腺特异性抗原(PSA)值A组 2例升高,B组随访 33例 1例升高 ( 6例近期完成手术者未复查),其余患者PSA均<0. 1ng/ml。　结论　随着手术技术的熟练和控尿技术的应用,LRP手术时间可缩短至 3h,恢复控     

The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments

PURPOSE: We determined the impact of radical retropubic prostatectomy on continence and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon, and completed the UCLA Prostate Cancer Index and American Urological Association (AUA) symptom index at baseline, 3, 6, 12 and 24 months after radical prostatectomy. Univariate analysis was performed to identify factors predisposing the early return of continence. RESULTS: A total of 100%, 98.3%, 97.1%, 94.2% and 98.6% of patients filled out the UCLA Prostate Cancer Index and AUA symptom index at baseline, and 3, 6, 12 and 24 months, respectively. Based on protective pad requirement or frequency of incontinence 100%, 90.9%, 87.2%, 92.1% and 98.5% vs 98.8%, 80.6%, 91.2%, 95.2% and 98.5% of men were continent at baseline, 3, 6, 12 and 24 months after surgery, respectively. Age, severity of lower urinary tract symptoms, Gleason score, nerve sparing status, blood loss or presence of benign prostatic tissue in the apical soft tissue margin did not predict early return of continence. All of the individual urinary symptoms captured by the AUA symptom score showed significant improvement after radical retropubic prostatectomy. Radical prostatectomy was associated with a mean 5.4 unit decrease in AUA symptom score (40% decrease) in men with baseline moderate/severe LUTS (AUA symptom score 8 or greater). CONCLUSIONS: The majority of men regain continence after radical retropubic prostatectomy and maximal continence is achieved by 24 months. No factors were identified that predicted early return of continence in our cohort of men undergoing radical prostatectomy. Radical prostatectomy has a clinically significant impact on improving LUTS.     

尿垫试验及调查表在根治性前列腺切除术后尿失禁随访中的应用

目的 :使用尿垫试验及调查表评价前列腺癌根治术后患者的尿失禁情况 ,观察尿失禁对生活质量的影响 ,研究保留尿道括约肌及患者年龄对术后尿失禁发生率的影响。　方法 :使用尿垫试验及调查表对 16 5例经耻骨后前列腺根治术患者进行连续性的 12～ 14个月的随访调查。患者保持与专职尿失禁护士的电话或直接联系 ,并于术后 12个月到门诊填写调查表、进行尿垫试验。按手术方法将病例分为括约肌修复组 (19例 )和括约肌保留组 (14 6例 ) ,对照观察效果 ;对年龄进行分组 (5 1～ 6 0岁组和 6 1～ 70岁组 )比较累积尿控制率的差异。　结果 :16 5例患者均获随访 :填写调查表并进行尿垫试验 ,7例患者回答使用尿垫而诊断为尿失禁 ,其中 1例有严重尿失禁 ,生活质量受到严重影响 ,其余 6例尿失禁轻 ,生活质量影响轻微 ;尿垫试验中 5例患者尿垫重量增加超过 1g而诊断为尿失禁 ,尿垫试验结果和调查表结果在诊断尿失禁上取得了 98.8%的一致率。按照尿失禁的一般诊断标准 ,本研究中尿道外括约肌保留组随访 12 + 个月时尿控率为 99.3% ,括约肌修复组为 94 .7% ;5 1～ 6 0岁组在刚拔除导尿管时 ,6 0 %的患者有尿失禁 ;6 1～ 70岁组在刚拔除导尿管时 ,82 %的患者有尿失禁 ,但在 3个月以后 ,两组趋于一致。　结论 :调查表与尿垫