Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution
Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution
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DOI：
10.1097/01.ju.0000138249.31644.ec
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发表时间：
2004-10-01
影响因子：
6.6
通讯作者：
Studer, UE
中科院分区：
文献类型：
--
作者：
Kessler, TM;Burkhard, FC;Studer, UE
目的：评估影响根治性膀胱前列腺切除术和回肠原位膀胱置换术后尿失禁和勃起功能的因素。材料与方法：1985年4月至2003年6月，381例连续行根治性膀胱切除术和原位膀胱置换的男性患者中，331例（87%）符合纳入标准，纳入分析。应用Kaplan-Meier模型和Cox回归多因素分析评价影响术后尿失禁和勃起功能的因素。结果：在单因素分析中，尝试神经保留和年龄小于65岁与更好的白天（分别p = 0.002和p = 0.007）和夜间失禁（分别p = 0.036和p = 0.005）显著相关。在多变量分析中，试图保留神经的患者白天尿失禁率显著高于对照组（风险比[HR] 1.4, 95%可信区间[CI] 1.05-1.87）， 65岁以下患者夜间尿失禁率显著优于对照组（风险比[HR] 1.39, 95%可信区间[CI] 1.07-1.8）。白天控制明显优于夜间控制（p < 0.0001），并且比夜间控制更快（p < 0.0001）。尝试保留神经的患者实现白天尿失禁的时间更短（p = 0.012）。在多变量分析中，试图保留神经的患者勃起功能恢复明显更频繁（HR 2.59, 95% CI 1.24-5.39）和年龄小于65岁的患者（HR 2.98, 95% CI 1.83-4.85）。结论：在根治性膀胱前列腺切除术和回肠原位膀胱置换后，尝试神经保留和年龄小于65岁与尿失禁改善相关。尝试神经保留对白天尿失禁的影响最大，年龄对夜间尿失禁的影响最大。尝试神经保留和年轻都与更频繁的勃起功能恢复有关。
Purpose: We assessed factors influencing urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution.Materials and Methods: Of 381 consecutive men undergoing radical cystoprostatectomy and Heal orthotopic bladder substitution between April 1985 and June 2003, 331 (87%) met the inclusion criteria and were enrolled in the analysis. Kaplan-Meier models and multivariate analysis applying Cox regression were used to evaluate factors influencing postoperative urinary continence and erectile function.Results: In univariate analysis, attempted nerve sparing and age younger than 65 years were significantly associated with better daytime (p = 0.002 and p = 0.007, respectively) and night-time continence (p = 0.036 and p = 0.005, respectively). In multivariate analysis the rate of daytime continence was significantly higher in patients with attempted nerve sparing (hazards ratio [HR] 1.4, 95% confidence interval [CI] 1.05-1.87) and nighttime continence was significantly better in patients younger than 65 years (HR 1.39, 95% CI 1.07-1.8). Daytime continence was significantly better (p < 0.0001) and was achieved more quickly than nighttime continence (p < 0.0001). The time to achieve daytime continence was shorter for patients with attempted nerve sparing (p = 0.012). In multivariate analysis erectile function recovered significantly more often in patients with attempted nerve sparing (HR 2.59, 95% CI 1.24-5.39) and in those younger than 65 years (HR 2.98, 95% CI 1.83-4.85).Conclusions: After radical cystoprostatectomy and ileal orthotopic bladder substitution, attempted nerve sparing and age younger than 65 years are associated with improved urinary continence. Attempted nerve sparing has the greatest impact on daytime continence and age has the greatest impact on nighttime continence. Attempted nerve sparing and younger age are both associated with more frequent recovery of erectile function.