提肛肌训练在改善前列腺电切术后下尿路症状中的效果评价

Efficacy of levator ani muscle training in improving postoperative lower urinary tract symptoms in patients undergoing electro-prostatectomy

目的探讨提肛肌训练在改善前列腺电切术后患者下尿路症状中的效果。方法对100例行前列腺电切术并拔除尿管后仍存在下尿路症状患者,采取不同的姿势,每天训练提肛肌3次,每次连续缩肛40次以上,每次收紧会阴部肌肉5~10 s。观察术前及术后不同时点国际前列腺症状(IPSS)评分、尿失禁问卷表简表(ICI-Q-SF)评分及术前、拔尿管后1、2、3个月的尿动力学指标。结果患者IPSS评分、ICI-Q-SF评分、最大尿流率时逼尿肌压、残余尿量随时间延长而降低(P<0.01),最大尿流率随时间延长而升高(P<0.01),且随时点延长改善越明显,以拔尿管后第60天时改善最显著。术后尿管的第15天后患者IPSS评分、ICI-Q-SF评分各时点比较,差异无统计学意义(P>0.05);而拔尿管第15天后各时点与第1天比较,差异有统计学意义(P<0.05)。结论提肛肌训练可有效改善患者下尿路症状,提高康复效果。

Objective To investigate the efficacy of levator ani muscle training in improving postoperative lower urinary tract symptoms （LUTS） in patients undergoing electro-prostatectomy.Methods A hundred patients still with LUTS after electro-prostatectomy and catheter removal were enrolled.Levator ani muscle training was performed in the patients for three times per day under different postures.More than 40 times of levator ani movement should be conducted continuously in each training,and muscle of perineum should be contracted for 5 - 10 s in each time.The international prostate symptom score （IPSS） and the score of Incontinence Qustionnaire-Short Form （ICI-Q-SF） were observed before operation and at different time points after operation.The urodynamics index was also observed before operation and at 1,2 and 3 months after catheter removal.Results The IPSS,ICI-Q-SF score,the pressure of detrusor at maximum flow rate and residual urine volume decreased with the increasing time （P〈0.01）,but maximum flow rate increased with the increasing time （P〈0.01）.And the improvement of those indices above were more obvious with the increasing time,especially at the 60 th day after catheter removal.Significant differences in the IPSS and ICI-Q-SF score were not found among the time points before the 15 th day after catheter removal （P〉0.05）,but were found between the 1 st day after catheter removal and each time points after the 15 th day after （P〈0.05）.Conclusion Levator ani muscle training can improve the LUTS of patients and the efficacy of rehabilitation.