肿瘤后前列腺切除术后尿失禁的最新诊断与治疗进展
Recent Advances in Diagnosing and Treating Post-Prostatectomy Urinary Incontinence
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影响因子:3.5
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 Nov
作者:
Yunlong Li, YingMing Xiao, Zhengang Shen, ShengKe Yang, Zeng Li, Hong Liao, Shukui Zhou
DOI:
10.1245/s10434-024-16110-1
摘要
根治性前列腺切除术和放射治疗是临床局限性前列腺癌的常用一线治疗方法。尽管手术技术和多学科管理不断进步，术后尿失禁（PPI）仍然是一种常见的临床并发症。PPI的发生率和持续时间具有高度异质性，个体之间差异显著。前列腺切除术后尿失禁可能由多种因素共同引起，包括患者特征、下尿路功能和手术操作。医生通常依靠详细的病史、体格检查、排尿日记、尿垫测试及问卷调查症状来识别关键因素并选择合适的治疗方案。根据失禁的严重程度和类型，PPI的治疗可分为保守治疗和外科干预。盆底肌肉训练和生活方式干预是常用的保守策略。当保守治疗失败时，常建议手术治疗，人工尿道括约肌仍是PPI的“金标准”手术干预。本综述基于最新的临床研究和指南建议，重点介绍PPI的流行病学、风险因素、诊断方法及治疗策略，旨在全面展示该领域的最新进展，并协助医生为PPI患者制定个性化的治疗方案。
Abstract
Radical prostatectomy and radiotherapy are common first-line treatments for clinically localized prostate cancer. Despite advances in surgical technology and multidisciplinary management, post-prostatectomy urinary incontinence (PPI) remains a common clinical complication. The incidence and duration of PPI are highly heterogeneous, varying considerably between individuals. Post-prostatectomy urinary incontinence may result from a combination of factors, including patient characteristics, lower urinary tract function, and surgical procedures. Physicians often rely on detailed medical history, physical examinations, voiding diaries, pad tests, and questionnaires-based symptoms to identify critical factors and select appropriate treatment options. Post-prostatectomy urinary incontinence treatment can be divided into conservative treatment and surgical interventions, depending on the severity and type of incontinence. Pelvic floor muscle training and lifestyle interventions are commonly conservative strategies. When conservative treatment fails, surgery is frequently recommended, and the artificial urethral sphincter remains the "gold standard" surgical intervention for PPI. This review focuses on the diagnosis and treatment of PPI, based on the most recent clinical research and recommendations of guidelines, including epidemiology and risk factors, diagnostic methods, and treatment strategies, aimed at presenting a comprehensive overview of the latest advances in this field and assisting doctors in providing personalized treatment options for patients with PPI.