改良经闭孔尿道球部悬吊术治疗男性前列腺切除术后压力性尿失禁的长期有效性和安全性

Long-term follow-up outcomes of modified transobturator bulbourethral sling suspension for post-prostatectomy incontinence

目的探讨改良经闭孔尿道球部悬吊术治疗男性前列腺切除术后压力性尿失禁(PPI)的安全性和临床有效性。方法回顾性分析2012年1月至2017年12月上海市第六人民医院泌尿外科收治的78例行改良经闭孔尿道球部悬吊术治疗男性PPI患者的临床资料,并通过尿失禁生活质量问卷(I-QOL)、每日尿垫使用量、1 h尿垫试验、残余尿量、最大尿流率检查的术前及术后随访情况评估其疗效与安全性。结果78例患者手术总成功率为79.5%,其中治愈率为56.4%,改善率为23.1%。患者术前I-QOL评分为(54.6±3.9)分,每日尿垫使用量为(3.6±0.7)块,1 h尿垫试验尿垫增重量为(33.6±5.0)g;患者术后3年的I-QOL评分为(80.4±5.7)分,每日尿垫使用量为(1.9±0.4)块,1 h尿垫试验尿垫增重量为(7.4±1.3)g,术后3年的I-QOL评分、每日尿垫使用量及1 h尿垫试验尿垫增重量较术前均有改善,差异具有统计学意义(P<0.05)。平均随访周期为(61.4±20.5)月,随访期间患者的I-QOL评分、每日尿垫使用量、1 h尿垫试验、残余尿量、最大尿流率比较,差异均无统计学意义(P>0.05),随访期间未发现远期并发症。结论改良经闭孔尿道球部悬吊术治疗男性PPI安全可行,术中术后无严重并发症,长期疗效稳定。

Objective To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence(PPI).Methods The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected.The incontinence quality of life(I-QOL)score,daily use of urine pad,1-hour urine pad test,residual urine volume(RUV),and maximum flow rate(Qmax)were assessed before and after surgery.Results The total success rate was 79.5%,of which the cure rate was 56.4%and the improvement rate was 23.1%.The preoperative I-QOL score was(54.6±3.9),daily use of urinary pad was(3.6±0.7),and increase in weight of the 1-hour urine pad test was(33.6±5.0)g.Three years after surgery,the I-QOL score was(80.4±5.7),daily use of a urinary pad was(1.9±0.4),and increase in weight of the 1-hour urine pad test was(7.4±1.3)g.Compared to preoperative status,the I-QOL score,daily use of urine pad,and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly(P<0.05).During the mean follow-up of(61.4±20.5)months,no significant changes in the I-QOL score,daily use of a urinary pad,1-hour urinary pad test,RUV or Qmax were observed,and no complications occurred.Conclusion Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence.The long-term efficacy is satisfactory.