经尿道Er∶YAG激光治疗前列腺癌根治术后轻中度压力性尿失禁的疗效观察  

Efficacy of Er∶YAG laser in the treatment of mild to moderate stress urinary incontinence after radical prostatectomy

作　　者：吕婷婷[1] 吕坚伟[1] 司俊文 蒋晨[1] 冷静[1] 薛蔚[1] LU Tingting;L Jianwei;SI Junwen;JIANG Chen;LENG Jing;XUE Wei(Department of Urology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201112,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海201112

出　　处：《现代泌尿外科杂志》2021年第11期922-926,949,共6页Journal of Modern Urology

摘　　要：目的观察经尿道Er∶YAG激光治疗前列腺癌根治术(RP)后轻中度压力性尿失禁的有效性和安全性。方法回顾性分析上海交通大学医学院附属仁济医院泌尿科盆底中心,自2018年12月至2020年6月收治的RP后尿失禁患者的临床资料。其中45例患者接受经尿道Er∶YAG激光的SMOOTH模式治疗为治疗组,37例患者接受生物反馈电刺激理疗为对照组。治疗前、治疗第9、18周及治疗后6个月随访时的主要观察指标包括:尿失禁发作频率(IEF)的相对变化、1 h尿垫试验评估。次要观察指标:尿失禁咨询问卷简表ICIQ-SF问卷评分、尿失禁生活质量问卷(I-QoL)评分、尿动力学指标、患者全身状况改善问卷(PGI-I)评分及不良反应。结果Er∶YAG激光治疗6次后IEF、1 h尿垫试验均较治疗前明显降低,且明显优于对照组。腹部漏尿点压(ALPP)、最大尿道闭合压(MUCP)也均较治疗前明显升高,I-QoL评分较治疗前也明显提高,患者全身状况改善情况(PGI-I≤3)“明显改善/有改善”达到73.33%。治疗结束时患者总有效率达66.7%,且治疗后经6个月随访,仍具有较好的疗效,且治疗期间均无不良反应。结论经尿道Er∶YAG激光是一种针对RP后轻中度压力性尿失禁的可选微创治疗方法,该疗法操作简单、安全有效,患者依从性好,为前列腺癌术后压力性尿失禁的治疗提供了新思路。Objective To observe the efficacy and safety of transurethral Er∶YAG laser in the treatment of mild to moderate stress urinary incontinence(SUI)after radical prostatectomy(RP).Methods Clinical data SUI patients after RP admitted to our hospital during Dec.2018 and Jun.2020 were retrospectively analyzed,including 45 treated with SMOOTH mode of transurethral Er∶YAG laser and 37 treated with biofeedback electrical stimulation(control group).The primary outcome measures included relative changes in incontinence episodes frequency(IEF)and 1 hour pad test evaluation before treatment,9 weeks,18 weeks and 6 months after treatment.The secondary outcome measures included the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF)questionnaire score,Incontinence-Quality of Life(I-QOL)score,urodynamic outcomes(abdominal leak point pressure,ALPP;maximum urethral closure pressure,MUCP),Patient Global Impression of Improvement(PGI-I)and adverse reactions.Results After 6 Er∶YAG laser treatments,the IEF and 1 hour pad test results were significantly reduced,and were significantly lower than those in control group.ALPP,MUCP,I-QoL score and PGI-I score significantly improved,and 73.33%patients had PGI-I≤3,indicating“significantly improved/improved”.At the end of the treatment,the total effective rate was 66.7%.After 6-month follow-up,good clinical efficacy was still maintained and no adverse reactions occurred.Conclusion Transurethral Er∶YAG laser is a minimally invasive therapy for mild to moderate SUI after RP.It is simple,safe and effective,with good patient compliance.

关 键 词：Er∶YAG激光 前列腺癌根治术 压力性尿失禁 SMOOTH模式 

分 类 号：R697[医药卫生—泌尿科学]