前列腺术后完全性尿失禁的手术治疗

Surgical treatment for post-prostatectomy incontinence

目的探讨手术治疗前列腺术后完全性尿失禁的效果。方法前列腺术后完全性尿失禁患者16例,包括耻骨上前列腺摘除术后2例,经尿道前列腺电切术后5例,经尿道前列腺气化术后8例,前列腺癌根治术后1例。年龄62～76岁,平均67岁。尿失禁病程10～22个月,经保守治疗无效。采用改良括约肌修补、球部尿道折叠加阴茎脚包埋术6例,球部尿道复合悬吊术10例。结果16例手术均顺利,无严重并发症。术后平均随访26个月,2组治愈、改善和无效者分别为3例和8例、1例和1例、2例和1例,成功率(治愈加改善)分别为66.7%和90.0%,总成功率为81.3%。结论改良括约肌修补、尿道球部折叠加阴茎脚包埋术和球部尿道复合悬吊术均为前列腺术后完全性尿失禁的有效治疗方法,但悬吊术的效果优于修补术。

Objective To evaluate the efficacy of surgical treatment for post-prostatectomy incontinence. Methods Sixteen patients (mean age,67 years;age range,62-76 years),with post-prostatectomy incontinence for 10-22 months, were included.Of them,2 cases had undergone suprapubic prostatectomy;5,transurethral electro-prostatectomy;8,transurethral vapo-resection of prostate;1,radical prostatectomy for prostatic carcinoma.Having failed to respond to conservative therapy,they were treated by either combination of sphincter fixation, bulbourethral plication and penile crural compression (group 1,n=6) or bulbourethral sling procedure (group 2,n=10). Results The procedures were successfully completed in 16 cases and no serious complication occurred.In group 1 and group 2,those who were cured, improved and did not respond to treatment were 3 vs 8,1 vs 1,2 vs 1,respectively.The overall success rate (cure plus improvement) was 81.3% for the whole series,and 66.7% for group 1 and 90% for group 2 after a mean follow-up of 26 months. Conclusions Both sphincter fixation,bulbourethral plication plus penile crural compression and bulbourethral sling procedure are effective surgical treatment for post-prostatectomy incontinence, but the latter is better.