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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 姜宜妮 | 攝護腺癌術後尿失禁新療法---尿道括約肌血小板再生術 | 2022/3/3 下午 06:11:41 | 0 |
| 原 文 | 題 目 | A novel management for postprostatectomy urinary incontinence: platelet-rich plasma urethral sphincter injection |
| 作 者 | Ping-Jui Lee , Yuan-Hong Jiang , Hann-Chorng Kuo | |
| 出 處 | Sci Rep. 2021 Mar 8;11(1):5371. doi: 10.1038/s41598-021-84923-1. | |
| 出版日期 | 2021 Mar | |
| 評 論 |
攝護腺癌為常見之男性癌症，手術和放射線治療對於局部攝護腺癌治癒率很高。然而，術後尿失禁可能嚴重影響病友的社交生活與生活品質。過去對於攝護腺癌術後尿失禁的治療以手術為主，隨著再生醫學的發達，血小板再生術首先被應用於顱顏整形手術、骨科手術，近年開始有泌尿學相關的研究 : 如勃起功能障礙、尿失禁、尿道狹窄、尿道下裂、膀胱注射等……。
本研究的主題是使用自體濃厚血小板注射於攝護腺癌術後的尿道括約肌，共觀察28位術後尿失禁的病友，平均年齡71.8歲。每月於尿道括約肌注射自體濃厚血小板，共四次，療程結束後再評估尿失禁治療效果和尿路動力學的變化。四次注射後，有六位病友(21.4%)尿失禁完全緩解，日常生活不用再使用護墊，有71.4%的患者反應良好(GRA score ≥ 2)，共26位病友(92.9%)有顯著臨床症狀改善。尿路動力學的漏尿狀況亦有改善。 本研究經統計分析，發現自體血小板再生術，這個相比於尿失禁手術(經恥骨吊帶和人工尿道括約肌)，相對侵入性低的治療方法，對於攝護腺癌術後尿失禁有令人滿意的療效。日後希望有更多研究仔細分析，適合的治療對象和長期效果。 |
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| abstract | Platelet-rich plasma (PRP) is the most innovative blood-derived product used in regenerative medicine. We aimed to investigate the therapeutic efficacy of PRP urethral sphincter injection for the management of postprostatectomy incontinence (PPI). In total, 28 PPI patients with a mean age of 71.8 ± 8.9 years were prospectively enrolled. They received four PRP urethral sphincter injections each month. The clinical outcomes were assessed 3 months after the fourth injection as posttreatment Global Response Assessment (GRA) score, the newly designed visual analogue scale of stress urinary incontinence (VAS of SUI), and in urodynamic parameters. After injections, the posttreatment median GRA with quartiles was 2.0 (1.0, 2.0). Overall, six (21.4%) patients achieved complete continence and pad-free status, 20 (71.4%) achieved successful outcome (GRA score ≥ 2), and 26 (92.9%) showed clinical improvement (GRA score ≥ 1). The VAS of SUI significantly improved from 6.5 (5.0, 8.0) to 3.5 (2.0-5.8) (p < 0.001) as well as abdominal leak point pressure, from 57.5 (50.0, 115.0) to 126.0 (68.3, 150.0), (p = 0.004). After repeated PRP urethral sphincter injections, the SUI severity reduced significantly with high success rates. There was no major adverse event, except three patients with mild hematuria and micturition pain. In conclusion, PRP urethral sphincter injection is safe and effective as a novel management of PPI. | |
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