前列腺术后尿失禁课件.pptVIP

吊带术 ( InVance) * 吊带术 ( InVance) 病例： 16 随访时间：12.2 月（4-20 月） 结果： 　　　　　88% 干 0-1个尿垫/日 　　　　　12% 改善 　　 -50%尿垫/日 Madjar S, et al. J Urol, 2001, 165:72-76. * 球部尿道包埋 * 残留梗阻 先处理梗阻，后处理尿失禁 残余腺体：TURP 膀胱颈痉挛：经尿道膀胱颈内切开 吻合口狭窄：经尿道狭窄段内切开 * Acta Urol Belg 1997 Dec;65(4):1-7 ?Urinary incontinence following transurethral, transvesical and radicalprostatectomy. Retrospective study of 489 patients.?Van Kampen M, De Weerdt W, Van Poppel H, Baert L.?Faculty of Physical Education and Physiotherapy, K.U. Leuven, Belgium.?Urinary incontinence following prostate surgery was evaluated in 489 consecutivepatients: 216 patients underwent a transurethral resection, 98 patients atransvesical prostatectomy for benign prostatic hyperplasia and 175 patients aradical prostatectomy for localized prostate cancer. In the first groupincontinence was present in 19% of the patients immediately after catheterwithdrawal, 16% after 1 month, 8% after 3 months, 3% and 2% after 6 and 9months, 1.5% after 1 year and 0.5% after 15 months. In the second groupincontinence was present in 15% immediately after catheter withdrawal, 12% after1 month, 5% after 3 months, 2% after 6 months and 1% after 9, 12 and 15 months.In the last group the incontinence rate was higher, 66% were incontinentimmediately after catheter withdrawal, 53% after 1 month, 33% after 3 months,12% after 6 months, 8% after 9 months. After 12 and 15 months still 2% hadproblems with persistent incontinence. These results compare favourably with theresults from the literature. The fact that a rehabilitation program wasintroduced for the patients with post-operative incontinence, may have been acontributing factor. * 由膀胱颈、前列腺和至精阜水平的前列腺部尿道组成，受来自盆神经的副交感神经纤维支配。前列腺手术将这部分括约肌切除，只留下远端尿道括约肌防止漏尿。 * 远端尿道括约肌从精阜延伸至球部尿道近侧，其组成包括[4]：⑴尿道粘膜皱折，起密封作用；⑵横纹肌括约肌（rhabdosphincter），由平滑肌和横纹肌组成； ⑶外源性尿道旁骨胳肌组织（extrinsic paraurethral skeletal musculature），含来自提肛肌复合体（levator ani complex）的成分；⑷筋膜支持组织。 * 横纹肌括约肌是一个同