How Should Continence and Incontinence after Radical Prostatectomy be Evaluated? A Prospective Study of Patient Ratings and Changes with Time
How Should Continence and Incontinence after Radical Prostatectomy be Evaluated? A Prospective Study of Patient Ratings and Changes with Time
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DOI：
10.1016/j.juro.2014.03.113
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发表时间：
2014-10-01
影响因子：
6.6
通讯作者：
Dahl, Alv A.
中科院分区：
文献类型：
--
作者：
Holm, Henriette Veiby;Fossa, Sophie D.;Dahl, Alv A.
目的：通过比较不同的定义，研究前列腺癌根治性前列腺切除术前后尿失禁的患病率和变化。我们还研究了Ellison等人对前列腺切除术后尿失禁的分级系统和前列腺切除术后12个月尿失禁的基线预测指标的描述有效性。材料和方法：这项全国前瞻性研究包括2005年至2009年间接受根治性前列腺切除术的844例患者。在基线和12个月的随访中，使用EPIC-50和UCLA-PCI验证问卷的735例患者（88%）报告了包括尿功能障碍和尿障碍在内的不良反应。通过线性回归分析来检验基线预测因素和前列腺切除术后尿失禁的程度。结果：根治性前列腺切除术后12个月，74%的患者报告前列腺切除术后尿失禁，其中40%的患者每天使用护垫，34%的患者报告偶尔滴尿而不使用护垫，26%的患者完全控制尿。根据Ellison等人的分层，当定义为完全失禁/无尿控制时，3%的男性报告了严重的前列腺切除术后尿失禁，但25%的男性报告了严重的前列腺切除术后尿失禁。术前失禁的患者中有14%在术后得到改善。前列腺切除术后尿失禁的预测因素为65岁及以上、不工作、性功能障碍和术前尿失禁。后两者在多变量分析中仍然是最强的预测因子。前列腺癌相关变量与前列腺切除术后尿失禁无关。结论：前列腺切除术后尿失禁的发生率因定义不同而有很大差异。在我们看来，尿失禁可以报告为任何渗漏，而不仅仅是尿垫的使用，并在症状量表上进行分级。术前性功能障碍和尿失禁是前列腺切除术后12个月随访中尿失禁的最强预测因子。
Purpose: We examined prevalence rates, and changes in continence and incontinence before and after radical prostatectomy for prostate cancer by comparing different definitions. We also studied the descriptive validity of the grading system of Ellison et al for post-prostatectomy incontinence and baseline predictors of post-prostatectomy incontinence at 12 months.Materials and Methods: This national prospective study included 844 patients treated with radical prostatectomy between 2005 and 2009. Adverse effects, including urinary dysfunction and bother, were reported by 735 patients (88%) using the EPIC-50 and UCLA-PCI validated questionnaires at baseline and 12-month followup. Linear regression analysis was done to examine baseline predictors and the degree of post-prostatectomy incontinence at followup.Results: At 12 months after radical prostatectomy 74% of patients reported post-prostatectomy incontinence, of whom 40% used pads daily, 34% reported occasional dribbling without pads and 26% had total urinary control. When defined as total incontinence/no urinary control, severe post-prostatectomy incontinence was reported by 3% of the men but 25% had severe post-prostatectomy incontinence according to the stratification of Ellison et al. Of patients with preoperative incontinence 14% improved postoperatively. Predictors of post-prostatectomy incontinence were age 65 years or greater, not working, sexual dysfunction and incontinence preoperatively. The latter 2 remained the strongest predictors on multivariate analysis. Prostate cancer related variables were not associated with post-prostatectomy incontinence.Conclusions: The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.