前列腺癌根治术后压力性尿失禁的发展规律

Urinary incontinence development following laparoscopic radical prostatectomy

目的探讨不同定义下的前列腺癌根治术后压力性尿失禁随时间的变化规律及其相关因素。方法 2010年3月至2013年11月,由同一术者完成腹腔镜前列腺癌根治术91例。患者年龄51~75岁,平均67岁。术前PSA0.1~50.8μg/L,中位数为10.3μg/L;Gleason评分5~8分;TNM分期T1c^T2c。术后10~17 d拔除尿管,分析其术后尿失禁的发生率及发展规律。控尿良好的定义分为不漏尿、有少量尿滴漏但不用尿垫以及每天使用尿垫不超过1张,共3种。结果随访1~45个月,平均18个月。根据3种不同的定义,术后拔除尿管后控尿率分别为0%、5%和33%,术后1个月为5%、22%和63%,术后3个月为30%、63%和93%,术后6个月为54%、88%和97%,术后12个月为76%、98%和100%。结论前列腺癌根治术后尿失禁常见,多数在术后6个月内好转。根据严格的控尿定义,近1/4患者在术后1年仍有尿失禁;但若根据宽松的控尿定义,则几乎所有患者均在1年内达到基本控尿。

Objective To assay the time-variations and relating factors of Stress Urinary Incontinence （SUI） after radical prostatectomy.Methods During Mar.2010 to Nov.2013,91 cases of laparoscopic radical prostatectomy were performed by a single surgeon,followed-up over 1 year.Basic information of all cases：the age range was 51 ～75 years,67 on average; PSA range before surgery was 0.1 ～50.8 μg/L,10.3 μg/L on median; the Gleason score was 6 ～ 8 ; and TNM stage range T1 c ～ T2c.The catheter removal undertook 2 weeks after operation,then analyzed the incontinence rate and development pattern of incontinence after surgery.Urinary continence defined as following 3 conditions：urine leakage free,little leakage without urinal pads or less than 1 pad per day.Results The follow-up visit range 1 ～45 months,18 on average.In line with the 3 definitions,urinary continence rate after catheter removal were：0％,5％ and 33％ ; 30％,63％ and 93％ by 3 months after surgery; 76％,98％ and 100％ by 12 months after surgery.Conclusions The SUI after laparoscopic radical prostatectomy is a common,however,the majority of which can improve within 3 ～ 6 months after surgery,and reach basic control in 1 year.