经尿道前列腺增生手术后尿失禁的研究进展

Research progress of urinary incontinence after transurethral benign prostatic hyperplasia

良性前列腺增生(benign prostatic hyperplasia,BPH)是老年男性的常见疾病,经尿道前列腺电切术和激光剜除术是目前治疗BPH的标准术式,然而,术后有一定比例的患者会并发短期或长期尿失禁,影响其生活质量。术前患有逼尿肌过度活动(detrusor overactivity,DO)或膀胱过度活动症(overactive bladder,OAB)、糖尿病、前列腺体积增大、膜性尿道长度(membranous urethral length,MUL)短、肥胖、括约肌损伤等因素可能增加术后尿失禁的发生风险。尿流动力学(urodynamics,UDS)检查是目前评估术后尿失禁原因的重要手段。药物治疗、盆底运动和电刺激有助于提高术后尿失禁的治愈率。手术治疗如膀胱内注射肉毒杆菌毒素-A(BYX-A)、可调式吊带系统、可调节植入球囊、人工尿道括约肌等可以缓解术后尿失禁,但需要进一步研究验证其治疗效果。

Benign prostatic hyperplasia(BPH)is a common disease in elderly men.Transurethral resection of the prostate and laser enucleation of the prostate are the standard methods for the treatment of BPH.However,short-term or long-term urinary incontinence might occur after surgery,which would affect the patients’quality of life.Preoperative detrusor overactivity(DO)or overactivity bladder(OAB),diabetes,enlarged prostate volume,short membranous urethral length(MUL),obesity,sphincter injury and other factors may increase the risk of urinary incontinence after transurethral prostatectomy.Urodynamic examination is an important method to evaluate the causes of postoperative urinary incontinence.Drug therapy,pelvic floor exercise and electrical stimulation could help to improve the cure rate of postoperative urinary incontinence.Surgical treatment,such as intravesical injection of botulinum toxin-A(BYX-A),adjustable sling system,adjustable balloon implantation and artificial urethral sphincter can alleviate postoperative urinary incontinence,but further studies are needed to verify the therapeutic effect.