前列腺癌患者根治术后尿失禁的预防

Prevention of incontinence after radical prostatectomy

目的探讨保护尿道膜部括约肌和神经血管束及重建膀胱颈部对前列腺癌根治术后尿失禁的预防作用。方法对32例前列腺癌采用保护尿道膜部括约肌和前列腺旁神经血管束，并在重建膀胱颈部黏膜充分外翻后的后壁行折叠缝合1针的方法，进行前列腺癌根治术，观察术后尿失禁发生情况。结果经6～72个月随访，全部患者排尿通畅，无肿瘤复发，除2例发生轻度尿失禁外，其余30例在6个月内均恢复尿控能力。结论保护尿道膜部括约肌和前列腺旁神经血管束，在充分外翻膀胱黏膜的重建膀胱颈后壁折叠缝合，能减少前列腺癌根治术后尿失禁的发生。

Objective To discuss the effect of urine control after radical retropubic prostatectomy by preserve the membranous part of sphincter urethrae and the neurovascular bundle, or to rebuild the bladder neck. Methods The radical retropubic prostatectomy was performed on a total of 32 cases of prostate cancer. We preserve the membranous part of sphincter urethrae and the neurovascular bundle lateral to the prostate. We evaginate the posterior wall of the bladder adequately and make an additional folding stitch to rebuild the bladder neck. Results The follow up is of 6-72 months. All patients could void without difficulty, no tumor recurrence and only 2 cases occurred slight incontinence. Other 30 cases regained the ability of controlling their urinations within 6 months. Conclusions The incontinence after radical retropubic prostatectomy could be reduced by the method of preserving the membranous part of sphincter urethrae and preserving the neurovascular bundle lateral to the prostate in operation. It could also be avoided by evaginate the posterior wall of the bladder adequately and make an additional folding stitch to the bladder neck.