Differences in Recurrence Rate and De Novo Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis.
Differences in Recurrence Rate and De Novo Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis.
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DOI：
10.3389/fsurg.2017.00044
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发表时间：
2017
影响因子：
1.8
通讯作者：
Rosenbaum CM
中科院分区：
文献类型：
--
作者：
Kranz J;Reiss PC;Salomon G;Steffens J;Fisch M;Rosenbaum CM
本研究的目的是比较根治性前列腺切除术（RP）后膀胱尿道狭窄（VUS）和经尿道前列腺电切术（TURP）后膀胱颈狭窄（BNS）内镜治疗后的复发率和原发性尿失禁。回顾性分析了2009年3月至2016年6月期间在三家德国三级医疗中心接受RP后VUS或TURP后BNS内镜治疗的患者。研究终点为复发率和原发性尿失禁。使用卡方检验和t检验来模拟组间差异。共有147例患者接受了VUS（59.2%）或BNS（40.8%）的内镜治疗。平均年龄为68.3岁（范围44-86），平均随访27.1个月（1-98）。初始治疗后的平均复发时间为23.9个月（1-156），既往内镜治疗VUS或BNS后的平均复发时间为12.0个月（1-159）。接受VUS治疗的患者在内镜治疗前接受放疗的频率明显更高（33.3 vs. 13.3%; p = 0.006），复发率明显更高（59.8 vs. 41.7%; p = 0.031）。TUR治疗VUS的成功率为40.2%，BNS的成功率为58.3%。BNS的TUR显著更成功（p = 0.031）。在成功病例中，BNS的TUR与VUS的TUR的平均次数分别为1.5与1.8，无显著差异。接受VUS治疗的患者的原发性尿失禁发生率显著更高（13.8 vs. 1.7%; p = 0.011）。排除内镜治疗前接受放疗的患者后，两组的复发率无显著差异（VUS组为60.3%，BNS组为44.2%; p = 0.091），而VUS治疗患者的原发性尿失禁发生率（VUS组为13.8%，BNS组为0%; p = 0.005）仍显著较高。大多数患有BNS的患者在内窥镜下成功治疗。VUS患者的成功率较低。两种狭窄在原发性尿失禁方面不同。必须告知患者内镜治疗VUS后新发尿失禁的风险增加，与既往放疗无关。需要更长时间的随访来解决长期结果。
The objective of this study was to compare the recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis (VUS) after radical prostatectomy (RP) and for bladder neck stenosis (BNS) after transurethral resection of the prostate (TURP). Retrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups. A total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44–86), mean follow-up 27.1 months (1–98). Mean time to recurrence after initial therapy was 23.9 months (1–156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1–159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p = 0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p = 0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p = 0.031). The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p = 0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p = 0.091), whereas the rate of de novo incontinence (13.8 for VUS vs. 0% for BNS; p = 0.005) stayed significantly higher in patients treated for VUS. Most patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de novo incontinence. Patients must be counseled regarding the increased risk of de novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.
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