医脉通编译整理，未经授权请勿转载。
导读
2019年5月，美国泌尿外科协会（AUA）联合女性尿动力学，盆腔医学及尿路重建学会（SUFU）发布了前列腺治疗后尿失禁（IPT）管理指南，IPT是为数不多的医源性泌尿疾病之一，采取适当措施是可以预防的。本文针对IPT的管理和预防提供了指导建议。医脉通编译整理指南重要内容，以期为大家临床工作带来帮助！
温馨提示：指南内容较多，可按照治疗前—治疗后—尿失禁的评估—治疗选择—术后并发症—特殊场景，查找对应内容。
治疗前
1.Clinicians should inform patients undergoing radical prostatectomy of all known factors that could affect continence. (Moderate Recommendation; Evidence Level: Grade B)
临床医生应告知接受根治性前列腺切除术的患者所有可能影响尿失禁的因素。（中等推荐；证据等级：B级）
2.Clinicians should counsel patients regarding the risk of sexual arousal incontinence and climacturia following radical prostatectomy. (Strong Recommendation; Evidence Level: Grade B)
临床医生应为根治性前列腺切除术后性兴奋和性高潮遗尿的患者提供建议。（强烈推荐；证据等级：B级）
3.Clinicians should inform patients undergoing radical prostatectomy that incontinence is expected in the short-term and generally improves to near baseline by 12 months after surgery but may persist and require treatment. (Strong Recommendation; Evidence Level: Grade A)
临床医生应告知接受根治性前列腺切除术的患者短期内将出现尿失禁，通常术后12月可改善至接近基线，但症状可能会持续并需要治疗。（强烈推荐；证据级别：A级）
4.Prior to radical prostatectomy, patients may be offered pelvic floor muscle exercises or pelvic floor muscle training. (Conditional Recommendation; Evidence Level: Grade C)
根治性前列腺切除术前，可为患者提供盆底肌肉锻炼。（有条件的推荐；证据级别：C级）
5.Patients undergoing transurethral resection of the prostate after radiation therapy or radical prostatectomy after radiation therapy should be informed of the high rate of urinary incontinence following these procedures. (Moderate Recommendation; Evidence Level: Grade C)
放疗后经尿道前列腺电切术或根治性前列腺切除术的患者，应知晓这些手术后尿失禁的高发生率。（中等推荐；证据级别：C级）
治疗后
6.In patients who have undergone radical prostatectomy, clinicians should offer pelvic floor muscle exercises or pelvic floor muscle training in the immediate post-operative period. (Moderate Recommendation; Evidence Level: Grade B)
临床医生应为根治性前列腺切除术的患者术后立即提供盆底肌锻炼。（中等推荐；证据级别：B级）
7.In patients with bothersome stress urinary incontinence after prostate treatment, surgery may be considered as early as six months if incontinence is not improving despite conservative therapy. (Conditional Recommendation; Evidence Level: Grade C)
对于前列腺治疗后出现
8.In patients with bothersome stress urinary incontinence after prostate treatment, despite conservative therapy, surgical treatment should be offered at one year post-prostate treatment. (Strong Recommendation; Evidence Level: Grade B)
前列腺治疗后严重的压力性尿失禁，尽管可采用保守治疗，但应在前列腺治疗1年后行手术治疗。（强烈推荐；证据级别：B级）
尿失禁的评估
9.Clinicians should evaluate patients with incontinence after prostate treatment with history, physical exam, and appropriate diagnostic modalities to categorize type and severity of incontinence and degree of bother. (Clinical Principle)
临床医生应根据病史、体格检查和适当的诊断方法评估治疗后尿失禁的患者，以便对尿失禁类型和严重程度进行分类。（临床原则）
10.Patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence should be offered treatment options per the American Urological Association Overactive Bladder guideline. (Clinical Principle)
对于急迫性尿失禁或以急迫性尿失禁为主的混合性尿失禁患者，应根据美国泌尿外科协会膀胱过度活动指南提供治疗方案。（临床原则）
11.Prior to surgical intervention for stress urinary incontinence, stress urinary incontinence should be confirmed by history, physical exam, or ancillary testing. (Clinical Principle)
在对压力性尿失禁手术干预前，应通过病史、体格检查或辅助检查确认压力性尿失禁。（临床原则）
12.Patients with incontinence after prostate treatment should be informed of management options for their incontinence, including surgical and non-surgical options. (Clinical Principle)
应告知前列腺治疗后尿失禁患者治疗方案，包括手术和非手术方案。（临床原则）
13.In patients with incontinence after prostate treatment, physicians should discuss risk, benefits, and expectations of different treatments using the shared decision-making model. (Clinical Principle)
对于前列腺治疗后尿失禁的患者，临床医生应讨论不同方案的风险、益处和预期。（临床原则）
14.Prior to surgical intervention for stress urinary incontinence, cystourethroscopy should be per formed to assess for urethral and bladder pathology that may affect outcomes of surgery. (Expert Opinion)
在对压力性尿失禁手术干预前，应行
15.Clinicians may perform urodynamic testing in a patient prior to surgical intervention for stress urinary incontinence in cases where it may facilitate diagnosis or counseling. (Conditional Recommendation; Evidence Level: Grade C)
为帮助诊断或咨询，临床医生可在患者接受压力性尿失禁手术前，对患者进行尿动力学检测。（有条件的推荐；证据等级：C级）
治疗选择
16.In patients seeking treatment for incontinence after radical prostatectomy, pelvic floor muscle exercises or pelvic floor muscle training should be offered. (Moderate Recommendation; Evidence Level: Grade B)
应为根治性前列腺切除术后寻求尿失禁治疗的患者提供盆底肌锻炼。（中等推荐；证据级别：B级）
17.Artificial urinary sphincter should be considered for patients with bothersome stress urinary incontinence after prostate treatment. (Strong Recommendation; Evidence Level: Grade B)
前列腺治疗后出现严重压力性尿失禁的患者，应考虑使用人工尿道括约肌。（强烈推荐；证据级别：B级）
18.Prior to implantation of artificial urinary sphincter, clinicians should ensure that patients have adequate physical and cognitive abilities to operate the device. (Clinical Principle)
人工尿道括约肌植入前，临床医生应确保患者有足够的认知操控该装置。（临床原则）
19.In the patient who selects artificial urinary sphincter, a single cuff perineal approach is preferred. (Moderate Recommendation; Evidence Level: Grade C)
选择人工尿道括约肌时，优选单袖套会阴入路。（中等推荐；证据级别：C级）
20.Male slings should be considered as treatment options for mild to moderate stress urinary incontinence after prostate treatment. (Moderate Recommendation; Evidence Level: Grade B)
对于前列腺治疗后的轻中度压力性尿失禁，应考虑使用男性吊带。（中等推荐；证据级别：B级）
21.Male slings should not be routinely performed in patients with severe stress incontinence. (Moderate Recommendation; Evidence Level: Grade C)
严重压力性尿失禁患者不应常规使用男性吊带。（中等推荐；证据级别：C级）
22.Adjustable balloon devices may be offered to patients with mild stress urinary incontinence after prostate treatment. (Moderate Recommendation; Evidence Level: Grade B)
可调球囊装置可用于前列腺治疗后轻度压力性尿失禁患者。（中等推荐；证据级别：B级）
23.Surgical management of stress urinary incontinence after treatment of benign prostatic hyperplasia is the same as that for patients after radical prostatectomy. (Moderate Recommendation; Evidence Level: Grade C)
良性前列腺增生术后应激性尿失禁的手术疗法与根治性前列腺切除术后方法相同。（中等推荐；证据级别：C级）
24.In men with stress urinary incontinence after primary, adjuvant, or salvage radiotherapy who are seeking surgical management, artificial urinary sphincter is preferred over male slings or adjustable bal loons. (Moderate Recommendation; Evidence Level: Grade C)
对于正在寻求手术治疗的原发性、辅助性或挽救性放疗后压力性尿失禁的患者，人工尿道括约肌优于男性吊带或可调节球囊。（中等推荐；证据级别：C级）
25.Patients with incontinence after prostate treatment should be counseled that efficacy is low and cure is rare with urethral bulking agents. (Strong Recommendation; Evidence Level: Grade B)
应告知前列腺治疗后尿失禁的患者：尿道扩张剂疗效较差，治愈的可能性极小。（强烈推荐；证据等级：B级）
26.Other potential treatments for incontinence after prostate treatment should be considered investigational, and patients should be counseled accordingly. (Expert Opinion)
前列腺治疗后尿失禁的其他潜在疗法正在研究中，应告知患者相关情况。（专家意见）
术后并发症
27.Patients should be counseled that artificial urinary sphincter will likely lose effectiveness over time, and reoperations are common. (Strong Recommendation; Evidence Level: Grade B)
应告知患者人工尿道括约肌可能随着时间的推移而失去效力，再次手术很常见。（强烈推荐；证据级别：B级）
28.In patients with persistent or recurrent urinary incontinence after artificial urinary sphincter or sling, clinicians should again perform history, physical examination, and/or other investigations to determine the cause of incontinence. (Clinical Principle)
对于人工括约肌或吊带术后持续性或复发性尿失禁的患者，临床医生应再次进行病史询问、体格检查和/或其他调查以确定尿失禁原因。（临床原理）
29.In patients with persistent or recurrent stress urinary incontinence after sling, an artificial urinary sphincter is recommended. (Moderate Recommendation; Evidence Level: Grade C)
对于吊带术后持续或复发性压力性尿失禁的患者，建议使用人工尿道括约肌。（中等推荐；证据级别：C级）
30.In patients with persistent or recurrent stress urinary incontinence after artificial urinary sphincter, revision should be considered. (Strong Recommendation; Evidence Level: Grade B)
对于人工括约肌术后持续性或复发性压力性尿失禁的患者，应考虑翻修。（强烈推荐；证据等级：B级）
特殊场景
31.In a patient presenting with infection or erosion of an artificial urinary sphincter or sling, explantation should be performed and reimplantation should be delayed. (Clinical Principle)
在人工尿道括约肌或吊带术后出现感染或侵蚀时，应取出移植物，并延迟植入。（临床原理）
32.A urinary diversion can be considered in patients who are unable to obtain long-term quality of life after incontinence after prostate treatment and who are appropriately motivated and counseled. (Expert Opinion)
对于前列腺治疗后尿失禁、无法获得长期生活质量的患者，可考虑尿流改道。（专家意见）
33.In a patient with bothersome climacturia, treatment may be offered. (Conditional Recommendation; Evidence Level: Grade C)
对于性高潮尿失禁患者，应进行治疗。（有条件推荐；证据级别：C级）
34.Patients with stress urinary incontinence following urethral reconstructive surgery may be offered artificial urinary sphincter and should be counseled that complications rates are higher. (Conditional Recommendation; Evidence Level: Grade C)
尿道重建术后压力性尿失禁的患者可采用人工尿道括约肌，应告知并发症发生率较高。 （有条件的推荐；证据级别：C级）
35.In patients with incontinence after prostate treatment and erectile dysfunction, a concomitant or staged procedure may be offered. (Conditional Recommendation; Evidence Level: Grade C)
对于前列腺治疗后尿失禁和勃起功能障碍的患者，可行同期或分期治疗。（有条件的推荐；证据级别：C级）
36.Patients with symptomatic vesicourethral anastomotic stenosis or bladder neck contracture should be treated prior to surgery for incontinence after prostate treatment. (Clinical Principle)
对于有症状的膀胱尿道吻合口狭窄或膀胱颈挛缩的患者，应在处理尿失禁前治疗狭窄或挛缩。（临床原则）
医脉通编译整理自：
Sandhu JS, Breyer B, Comiter C,et al. Incontinence after Prostate Treatment: AUA/SUFU Guideline. J Urol. 2019 May 6:101097JU0000000000000314. doi: 10.1097/JU.0000000000000314. [Epub ahead of print]
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