Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence
Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence
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DOI：
10.1016/s0022-5347(01)65724-0
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发表时间：
1996-09-01
影响因子：
6.6
通讯作者：
Gormley, EA
中科院分区：
文献类型：
--
作者：
Gudziak, MR;McGuire, EJ;Gormley, EA
目的：尿道轮廓术直接测量最大尿道压已被广泛应用于尿道括约肌功能的评估。我们试图确定最大尿道压力（在尿道膜水平测量）或尿道外括约肌功能与导致尿道切除术后失禁男性患者漏尿所需的腹压（腹漏点压力）之间是否存在任何关系。我们还研究了外括约肌功能和尿道incontinent.Materials和方法之间的关系：我们回顾性评价了37名男性尿道切除术后尿失禁的氟尿动力学。尿动力学研究包括测量最大尿道和腹部漏尿点压力，并通过压力测量和X线片评估外括约肌功能。结果：27例患者的腹部漏尿点和最大尿道压力进行了分析。平均最大尿道压为52.5 cm。水（范围20至165），平均腹部泄漏点压力为77.8厘米。水（范围27至132）。对最大尿道漏尿点压和最大腹腔漏尿点压进行回归分析。计算出Pearson相关系数为0.13834（p = 0.4914），表明我们样本中的2个测量值之间几乎没有相关性。所有患者的尿道外括约肌均正常。37例患者中只有1例没有内在括约肌缺陷的证据，即没有尿漏伴腹压升高，患者仅因膀胱功能障碍而失禁（逼尿肌不稳定）。结论：我们的研究表明尿道切除术后由于腹压增加而引起的尿失禁（压力性尿失禁）不依赖于外括约肌功能，并且与最大尿道压力无关。我们的结论是，尿道切除术后尿失禁由于括约肌功能障碍的结果，从内在的括约肌缺陷。根据我们的经验，膀胱功能障碍很少是膀胱切除术后尿失禁的唯一原因。
Purpose: Direct measurement of maximum urethral pressure by urethral profilometry has been used widely to assess urethral sphincter function. We attempted to determine if there was any relationship between maximum urethral pressure, which is measured at the level of the membranous urethra, or extrinsic urethral sphincter function, and the amount of abdominal pressure needed to cause leakage (abdominal leak point pressure) in men with postprostatectomy incontinence. We also examined the relationship between external sphincter function and continence or incontinence.Materials and Methods: We retrospectively evaluated fluoro-urodynamics performed in 37 men with post-prostatectomy incontinence. Urodynamic study consisted of measurement of maximum urethral and abdominal leak point pressures, and assessment of extrinsic sphincter function by pressure measurements and radiographically.Results: Data were analyzed on 27 patients for whom abdominal leak point and maximum urethral pressures were available. Mean maximum urethral pressure was 52.5 cm. water (range 20 to 165) and mean abdominal leak point pressure was 77.8 cm. water (range 27 to 132). Regression analysis was performed between maximum urethral and abdominal leak point pressures. A Pearson correlation coefficient of 0.13834 was calculated (p = 0.4914) indicating virtually no correlation between the 2 measurements in our sample. Extrinsic urethral sphincter was normal in all patients. Only 1 of 37 patients had no evidence of intrinsic sphincter deficiency, that is there was no urine leakage with increases in abdominal pressure and the patient was incontinent solely based on bladder dysfunction (detrusor instability).Conclusions: Our study indicates that incontinence after prostatectomy due to an increase in abdominal pressure (stress incontinence) does not depend on extrinsic sphincter function and is not related to maximal urethral pressure. We conclude that post-prostatectomy incontinence due to sphincter dysfunction results from intrinsic sphincter deficiency. In our experience bladder dysfunction is rarely the sole cause of post-prostatectomy incontinence.