EFFECT OF TRANSURETHRAL RESECTION OF THE PROSTATE ON DETRUSOR INSTABILITY AND URGE INCONTINENCE IN ELDERLY MALES
EFFECT OF TRANSURETHRAL RESECTION OF THE PROSTATE ON DETRUSOR INSTABILITY AND URGE INCONTINENCE IN ELDERLY MALES
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DOI：
10.1002/nau.1930120502
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发表时间：
1993-01-01
影响因子：
2
通讯作者：
MCPHEE, MS
中科院分区：
文献类型：
--
作者：
GORMLEY, EA;GRIFFITHS, DJ;MCPHEE, MS
逼尿肌不稳定在良性前列腺肥大导致流出道梗阻的男性中很常见，通常在经尿道前列腺切除术（TURP）后约三分之二的患者中逆转。它也常见于无流出道梗阻的老年人，并可能导致急迫性尿失禁。为了确定TURP是否对老年男性逼尿肌不稳定和急迫性尿失禁有影响，或者这些异常是否是由于其他年龄相关的变化，12名男性对20例（平均年龄80岁）有急迫性尿失禁或尿频尿急症状的良性前列腺增生症患者行TURP术前、术后24小时尿失禁监测和视频尿动力学检查;术前所有患者均表现出逼尿肌不稳定，术后仅有1例患者发生逆转，这一比例明显低于年轻患者。术前，11/12例患者失禁。TURP后，8/11例患者的尿失禁量有所改善，24小时内最多可达458 g。那些改善的患者术前尿动力学阻塞更严重。我们的结论是，在老年人群中，逼尿肌不稳定和急迫性尿失禁可能是与年龄相关的变化的结果，而不是继发于梗阻。TURP术后逼尿肌不稳定可能持续存在。术前尿动力学评估梗阻的失禁男性良性前列腺肥大可能是有用的，因为尿失禁的严重程度，如果有显着的梗阻TURP反应良好。认知障碍不应成为手术的障碍。 (C)1993 Wiley-Liss，Inc.
Detrusor instability is common in men with evidence of outflow obstruction due to benign prostatic hypertrophy and typically reverses in about two thirds of patients after transurethral resection of the prostate (TURP). It is also common among the elderly without outflow obstruction and may lead to urge incontinence. To determine whether TURP has an effect on detrusor instability and urge incontinence in elderly men, or whether these abnormalities are due to other age-associated changes, 12 males (mean age 80 years) with urge incontinence or frequency and urgency of micturition, and symptomatic benign prostatic hypertrophy, were studied by 24-hour monitoring of incontinence and videourodynamic examination, before and after TURP; 7/12 patients were significantly cognitively impaired.Preoperatively, all patients showed detrusor instability, which reversed postoperatively in only one patient, a significantly smaller proportion than that consistently reported in younger patients. Preoperatively, 11/12 patients were incontinent. After TURP, 8/11 patients had an improvement in the amount of incontinence, by up to 458 g in 24 hours. Those who improved had been urodynamically more severely obstructed preoperatively. Those with the most improvement were also cognitively impaired.We conclude that, in the geriatric population, detrusor instability and urge incontinence may be the result of age-associated changes' and not secondary to obstruction. Detrusor instability is likely to persist following TURP. Preoperative urodynamic assessment of obstruction in the incontinent male with benign prostatic hypertrophy may be useful since the severity of incontinence responds well to TURP if there is marked obstruction. Cognitive impairment should not be a deterrent to operation. (C) 1993 Wiley-Liss, Inc.