根治性前列腺切除术后尿失禁的预防及干预

Prevention and Intervention of Urinary Incontinence after Radical Prostatectomy

根治性前列腺切除术是男性压力性尿失禁最常见的原因。尿道括约肌、提肛肌、耻骨前列腺韧带、膀胱颈、盆内筋膜、神经血管束等多种解剖结构影响或可能影响尿失禁,了解盆底和尿道的解剖结构对获得满意的功能结果至关重要。为提高控尿率而实施的外科手术包括保留神经、膀胱颈或尿道长度、重建肌肉筋膜、保留耻骨前列腺韧带或保留精囊。围手术期(术前和术后)盆底肌肉训练可以缩短术后尿失禁时间,从而提高术后早期控尿率。

Radical prostatectomy is the most common cause of stress urinary incontinence in men.Several anatomic structures like urethral sphincter,levator ani muscle,puboprostatic ligaments,bladder neck,endopelvic fascia,neurovascular bundle affect or may affect urinary continence,so understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome.Surgical techniques implemented to improve continence rates include nerve-sparing procedure,bladder neck preservation/plication,urethral length preservation,musculofascial reconstruction,puboprostatic ligaments preservation or seminal vesicle preservation.Perioperative(preoperative and postoperative)pelvic floor muscle training aims to shorten the duration of postoperative urinary in continence and thus,improve early continence rates postoperatively.