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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 林威宇 | 攝護腺手術後的尿失禁問題 | 2013/5/30 下午 08:15:12 | 0 |
| 原 文 | 題 目 | 新式尿失禁可調控系統針對男性尿失禁的初步治療結果歐洲多中心經驗報 |
| 作 者 | M. Raschid Hoda, et al | |
| 出 處 | BJU Int. | |
| 出版日期 | 2012 .6月 | |
| 評 論 |
攝護腺癌逐漸受到國人的重視，目前已高居男性十大癌症第五位。越來越多病人因為篩檢得以早期發現，進一步接受手術治療。然而，尿失禁的問題也是手術治療併發症。尤其在更嚴重的攝護腺癌病人接受手術的時候，泌尿科醫師常常要面對”癌症控制”與”下泌尿功能保存”這兩者的抉擇。術後尿失禁復原與病人年紀有關，年紀小於60歲的病人攝護腺手術95%可達到免用防護墊的情形，而年紀>70歲的病人85%可達到無漏尿的情形。 對於男性尿禁的手術選擇包括膠質注射、人工括約肌植入或男性懸吊帶置放，在近幾年來各種不同”微創”的懸吊帶系統已經被認為是治療攝護腺切除術後併發尿失禁的治療選項。但是使用男性懸吊帶的缺點之一是無法做術後植入的調整，為了因應術中或術後男性懸吊帶調整此般挑戰，新式尿失禁可調控系統(ATOMS)應孕而生。 在目前初步的結果經過歐洲多個測驗中心的評估發現，此一新式系統可以相當有意義改善尿失禁的嚴重度及生活品質，因此建議在未來可用在男性尿失禁病患的治療選擇上。 |
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| abstract |
Objective • To report our experience with a new self-anchoring adjustable transobturator male system (ATOMS®; AMI, Vienna, Austria) for the treatment of stress urinary incontinence (SUI) in men. Patients and Methods • A total of 99 men, in a number of centres, were treated for SUI with the new ATOMS® device. • The device was implanted in all patients using an outside-in technique by passing the obturator foramen and anchoring the device to the inferior pubic ramus. The titanium port was placed s.c. on the left symphysis region. Adjustments were performed via port access. • Postoperative evaluation consisted of physical examination, 24-h pad test, and 24 h-pad count. Preoperatively and at 6-month follow-up, patients completed a validated quality-of-life questionnaire. • Two-way ANOVA was used to analyse changes over time. Within-group effects for time were tested using post hoc Dunnett’s contrasts of baseline values vs subsequent measurements. Results • The most common indication was SUI after radical prostatectomy (92.9%). Failure of previous surgeries was present in 34.3% patients and 31.3% patients had undergone secondary radiation. • The mean (SD; range) surgery time was 47 (13.8; 29–112) min. • Temporary urinary retention occurred in two patients (2%) and transient perineal/scrotal dysaesthesia or pain was reported by 68 patients (68.7%) and resolved after 3–4 weeks of non-opioid analgesics. • There were four (4%) cases of wound infection at the site of the titanium port leading to explantation.No urethral or bladder injuries related to the device or erosions occurred. • The mean (SD; range) number of adjustments to reach the desired result (dryness, improvement and/or patient satisfaction) was 3.8 (1.3; 1–6). After a mean (SD; range) follow-up time of 17.8 (1.6; 12–33) months, the overall success rate was 92% and the mean pad use decreased from 7.1 to 1.3 pads/24 h (P 0.001).Overall, 63% were considered dry and 29% were improved. Conclusion • Treatment of male SUI with this self-anchored adjustable system is safe and effective. Keywords incontinence, prostatectomy, transobturator mesh, adjustable, quality of life |
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