A longitudinal assessment of bowel related symptoms and fecal incontinence following radical perineal prostatectomy
A longitudinal assessment of bowel related symptoms and fecal incontinence following radical perineal prostatectomy
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DOI：
10.1097/01.ju.0000065116.20997.a3
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发表时间：
2003-06-01
影响因子：
6.6
通讯作者：
Paulson, DF
中科院分区：
文献类型：
--
作者：
Dahm, P;Silverstein, AD;Paulson, DF
目的：最近的研究表明，会阴根治性前列腺切除术后大便失禁的发生率增加。我们对接受会阴根治性前列腺切除术患者的肠道相关症状进行前瞻性和纵向评估。材料与方法：回顾性分析了2001年1月1日至12月31日行会阴根治性前列腺切除术的78例患者，随访时间为6个月。患者信息从图表和肠域特定问题的验证生活质量问卷，扩大前列腺癌指数复合。术前、术后4周及术后每隔3个月进行问卷调查。计算每个间隔的平均肠功能、烦恼和总体健康相关生活质量评分。与基线相比，新出现或加重症状的持续时间采用Kaplan-Meier分析进行评估。结果：78例患者中有11.5%（9例）和19.2%（15例）出现不自觉便漏和直肠急迫症状。虽然手术后所有肠道相关症状都短暂增加，但直肠急症是最持久的症状，但90%以上的患者在9个半月内恢复正常。与个体基线相比，15.4%、7.7%、5.1%和3.9%的患者报告在3个月、6个月、9个月和12个月后大便失禁症状加重。在69例术前否认大便失禁的患者中，会阴根治性前列腺切除术后12个月的非随意便漏发生率为2.9%。10例患者中，9例在前列腺切除术后6个月个体健康相关生活质量评分恢复。结论：对自我报告问卷数据的纵向评估表明，与基线相比，会阴前列腺根治性切除术后大便失禁和肠道相关症状更为普遍，但大多数患者在术后早期随着时间的推移得到缓解。
Purpose: Recent studies have suggested an increased incidence of fecal incontinence following radical perineal prostatectomy. We provide a prospective and longitudinal assessment of bowel related symptoms of patients undergoing radical perineal prostatectomy.Materials and Methods: A total of 78 patients who underwent radical perineal prostatectomy between January I and December 31, 2001 and had a minimal followup of 6 months were included in the analysis. Patient information was obtained from the chart and the bowel domain specific questions of a validated quality of life questionnaire, the Expanded Prostate Cancer Index Composite. The questionnaire was administered to the candidates preoperatively, at 4 weeks following surgery and subsequently at 3-months intervals. A mean bowel function, bother and summary health related quality of life score was calculated at each interval. The duration of new or worsened symptoms with respect to baseline was evaluated using Kaplan-Meier analysis.Results: Symptoms of involuntary stool leakage and rectal urgency were reported by 11.5% (9 of 78) and 19.2% (15) of patients preoperatively. While all bowel related symptoms transiently increased following surgery, rectal urgency was the most persistent symptom, yet normalized in more than 90% of patients within 9 1/2 months. Compared to individual baseline 15.4%, 7.7%, 5.1% and 3.9% of patients reported worsened symptoms of fecal incontinence after 3, 6, 9 and 12 months, respectively. In the subset of 69 patients who denied preoperative fecal incontinence the incidence of involuntary stool leakage was 2.9% by 12 months following radical perineal prostatectomy. Of 10 patients 9 recovered individual health related quality of life score by 6 months after prostatectomy.Conclusions: Longitudinal assessment of self-reported questionnaire data suggests that fecal incontinence and bowel related symptoms are more prevalent following radical perineal prostatectomy compared to baseline, yet resolve in the majority of patients with time in the early postoperative period.