盆底磁刺激治疗根治性前列腺切除术后尿失禁

Extracorporeal magnetic innervation in the treatment of urinary incontinence after radical prostatectomy

背景：盆底磁刺激是近年来兴起的治疗尿失禁的新疗法。目前关于盆底磁刺激治疗根治性前列腺切除术后尿失禁国外仅有一个中心的研究报道。目的：对比分析了盆底磁刺激和盆底肌锻炼治疗根治性前列腺切除术后尿失禁患者的疗效。设计、时间及地点：随机对照临床试验，于2005-02/2007-02在解放军第四军医大学西京医院泌尿外科完成。对象：根治性前列腺癌切除术后出现尿失禁患者24例，随机分为盆底磁刺激组和盆底肌锻炼组，每组12例。方法：分别接受盆底磁刺激和盆底肌锻炼治疗，盆底磁刺激频率为10Hz，间歇持续10min后休息3min，继而调节频率为50Hz，反复刺激20min，每次治疗过程为30min左右，每周2次。盆底肌锻炼治疗患者取侧卧位，嘱其作肛门收缩与放松动作，并类似于排尿时突然中断排尿样收缩肛门括约肌，同时保持腹肌松弛。每次收缩持续3s，然后缓慢放松3s，连续训练20min，每日3次。连续治疗6周。主要观察指标：采用生活质量评分和国际尿失禁咨询委员会制定的尿失禁问卷表简表评分进行疗效评价。结果：24例患者全部进入结果分析。治疗前，2组尿失禁问卷表简表评分差异无显著性意义，治疗1个月后盆底磁刺激组和盆底肌训练组患者尿失禁评分和生活质量评分均下降（P〈0.05-0.01），两组比较差异无显著性意义，治疗后3个月及6个月两组评分继续降低，盆底磁刺激治疗组患者尿失禁评分和生活质量评分均低于盆底肌训练组（P〈0.05）。两组均无治疗并发症发生。结论：盆底磁刺激疗法对于根治性前列腺切除术后尿失禁的治疗效果显著，优于盆底肌锻炼。

BACKGROUND： Extracorporeal magnetic innervation （ExMI） has been developed for the stimulation of pelvic floor muscles. It is a novel therapy for urinary incontinence. To date, there is only one report from abroad about the stimulation of pelvic floor muscles by ExMI for urinary incontinence following radical prostatectomy. OBJECTIVE： To compare and analyze the treatment effect of ExMI and pelvic floor muscle exercise （PFME） on urinary incontinence after radical prostatectomy. DESIGN, TIME AND SETTING： The randomized controlled clinical trial was performed at the Department of Urology, Xijing Hospital of Fourth Military Medical University of Chinese PLA from February 2005 to February 2007. PARTICIPANTS： Twenty-four patients with urinary incontinence after radical prostatectomy were randomly assigned to ExMI group and PFME group （n =12）. METHODS： For ExMI group, the frequency of the pulse field was 10 Hz for 10 minutes, followed by a 3 minutes rest and a second treatment at 50 Hz for 20 minutes. The treatment lasted for 30 minutes every time and twice a week. The patients in PFME group were advised to do the exercise of anal contraction and relaxation, anal sphincter contraction similar to sudden interruption of urination by keeping abdominal muscle relaxation. The contraction was for 3 seconds each time followed by a 3- second rest, 20 minutes once, 3 times a day for successive 6 weeks. MAIN OUTCOME MEASURES： The therapeutic effect was evaluated by Quality-of-Life Scale and the International Continence Inquiring Committee Questionnaire Short Form （ICI-Q-SF）. RESULTS： Twenty-four patients were all included in final analysis. There were no significant differences in ICI-Q-SF scores between two groups before treatment. After one month of treatment, both scores for the Quality-of-Life Scale and ICI-Q-SF were decreased （P 〈 0.05-0.01）, and there were no significant differences between two groups. After 3 months and 6 months of treatment, the scores of two scales continued to decrease, and those of ExMI group were significantly lower than those of PFME group （P 〈 0.05）. No complications were noted in any of the groups. CONCLUSION： ExMI is superior over PFME in treating urinary incontinence after radical prostatectomy.