學術論壇
學術論壇可提供瀏覽者及一般會員閱讀瀏覽學術文章。
您必須為協會會員或專科醫師才可擁有發表文章及討論之權限。
您必須為協會會員或專科醫師才可擁有發表文章及討論之權限。
| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳俞安 | 骨盆底肌肉運動對於接受達文西手臂前列腺根除術後尿失禁的影響之統合分析研究 | 2023/1/3 下午 05:45:26 | 0 |
| 原 文 | 題 目 | The Effect of Preoperative Pelvic Floor Muscle Training on Incontinence Problems after Radical Prostatectomy: A Meta-Analysis |
| 作 者 | Ervandy Rangganata Harrina Erlianti Rahardjo | |
| 出 處 | Urology Journal, Vol. 18 No. 04 (2021), Page 380-388 | |
| 出版日期 | 28 April 2021 | |
| 評 論 | 前列腺癌在已開發國家中，尤其歐洲美國是男性癌症發生率前三名的癌症，在台灣攝護腺癌佔整體男性癌症的比例也逐漸提高。根據過去的大型觀察與追蹤言型研究，在經過前列腺根除術後的病人有大約18~28% 的病人在術後有不同程度的尿失禁，從輕微的只有咳嗽等用力的動作才會漏尿到嚴重的即便靜止也會漏尿。在婦女的尿失禁病人，例如多胎自然產後骨盆底肌肉運動（凱格爾運動）對於尿失禁有程度上的改善，因此試想此治療是否可以應用在男性經過前列腺根除術後的病人身上。此統合分析收錄數篇臨床的對照研究發現在術前有先做骨盆底肌肉運動的病人族群，在接受達文西手臂前列腺根除術後的初期(術後一年內)有顯著減少尿失禁的比例。在術後第一個月比起對照組減少了42%尿失禁發生率[OR 0.58, 95% CI, 0.41–0.81)], 術後第三個月減少43% [OR 0.57 (95% CI, 0.43–0.74)], 術後第六個月減少62% [OR 0.38 (95% CI, 0.17–0.83)]。然後在術後一年有沒有在術前做凱格爾運動對於尿失禁的發生沒有顯著影響。這跟我們在臨床上的發現大致吻合，大部分在達文西前列腺根除術後的病人一開始雖然大約有三分之一的病人有不同程度的尿失禁，但是大部分的病人都可以在半年內慢慢恢復禁尿的能力。這可能與達文西手術的高解析度，較好的手術視野與立體視覺，讓手術醫師可以盡量保存尿道括約肌或者進行骨盆底肌肉的重建，達到術後的禁尿能力。臨床醫師也可以鼓勵病人在術前做骨盆底運動以更快恢復禁尿能力。 | |
| abstract |
Purpose: To evaluate whether additional pelvic floor muscle training (PFMT), which began before radical prostatectomy and resumes immediately after catheter removal, will significantly improve urinary incontinence after RP. Materials and Methods: We reviewed articles obtained from MEDLINE, CENTRAL, EBSCOHost, CINAHL, and Elsevier from July – August 2020, which compared preoperative PFMT with postoperative PMFT or non-PFMT, with continence incidence parameters. There were no restrictions on the definition of incontinence, treatment regimens, and radical prostatectomy surgical approach. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. A meta-analysis was also carried out to pool the effect estimates. Results: We included 12 eligible studies in this review, 11 of which we included in the meta-analysis. The PFMT initiated preoperatively significantly reduced the incidence of persistent urinary incontinence at 1, 3, and 6 months postoperatively with an OR of 0.58 (95% CI, 0.41–0.81), 0.57 (95% CI, 0.43–0.74), and 0.38 (95% CI, 0.17-0.83). There was no difference in improvement in patients' incontinence at 12 months postoperatively [OR = 1.31 (95% CI, 0.65-2.63)]. Conclusion: PFMT initiated before radical prostatectomy significantly reduced the incidence of urinary incontinence in the first, third, and sixth months postoperatively. At 12 months postoperatively, additional preoperative PFMT did not cause a significant difference in urinary incontinence incidence. |
|
| 回覆發表 | 回覆討論主題內容 | 最後發表 |
| 目前尚無任何相關的回覆資料 | ||