Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up
Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up
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DOI：
10.1111/j.1464-410x.2006.06185.x
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发表时间：
2006-06-01
影响因子：
4.5
通讯作者：
Artibani, Walter
中科院分区：
文献类型：
--
作者：
Sacco, Emilio;Prayer-Galetti, Tommaso;Artibani, Walter
目的探讨临床局限性前列腺癌根治性耻骨后前列腺切除术（RRP）后尿失禁的危险因素，比较不同定义对尿失禁率的影响。患者与方法对1986年1月至2001年12月在我科连续1144例行RRP手术的患者进行尿失禁评估，问卷由第三方填写。总体而言，985名男性（86%）适合评估（平均年龄64.5岁，平均随访95.5个月）。我们比较了三种定义对尿失禁精算率的影响：(1)不使用或偶尔使用便笺；(2)每天使用0或1个护垫，但只用于偶尔的运球；(3)每天0-1片。尿失禁恢复的时间定义为患者符合尿失禁定义的日期。还评估了尿失禁对健康相关生活质量（HRQoL）的影响。使用前瞻性收集的数据，采用单因素和多因素分析来确定尿失禁的预测因素。结果RRP术后24个月末次随访时，符合定义1、2、3的男性尿失禁率分别为83%、92.3%和93.4%。与其他组相比，定义1恢复尿失禁的时间差异显著（P < 0.001）。大多数每天使用1块护垫的男性只抱怨偶尔运球（89.3%），认为自己有节制（98%），他们的HRQoL没有那些每天使用>= 2块护垫的人受到严重影响。男性尿失禁（定义为3）2年时，在最后一次随访时保留尿失禁的精算概率为72.2%。多因素分析显示，手术年龄（P = 0.009）、吻合口狭窄和随访时间间隔（P < 0.001）是独立的预后因素。双侧神经血管束切除术是另一个独立的预测因素（P = 0.03），在最后560名有手术技术资料的男性中。随着时间的推移，失禁发生率的降低高达86%。结论尿失禁在RRP术后2年内逐渐改善，但部分患者在术后出现尿失禁。使用护垫的标准在生活质量有限下降的男性（不使用或使用一个护垫）和生活质量明显受影响的男性（>= 2个护垫/天）之间有很好的区别。将1 pad/d的服用者视为大陆可能在临床上是有效的。年龄、双侧神经血管束切除及吻合口狭窄是尿失禁的重要危险因素。术后尿失禁和吻合口狭窄的发生率随时间的延长有明显的下降趋势。
Objective To investigate the incidence of urinary incontinence and its development over time, to compare the effects of alternative definitions on the incontinence rate and to explore risk factors for incontinence after radical retropubic prostatectomy (RRP) for clinically localized prostate cancer.Patients and Methods Urinary continence was assessed using a questionnaire administered by a third party in 1144 consecutive patients after undergoing RRP at our department from January 1986 to December 2001. Overall, 985 men (86%) were suitable for evaluation (mean age 64.5 years, mean follow-up 95.5 months). We compared the effects of three definitions on the actuarial rate of continence: (1) no or occasional pad use; (2) 0 or 1 pads used daily, but for occasional dribbling only; (3) 0-1 pads daily. The time to recovery of continence was defined as the date on which the patient met the continence definitions. The impact of incontinence on health-related quality of life (HRQoL) was also evaluated. Univariate and multivariate analyses were used to identify predictors of incontinence, using data gathered prospectively.Results At the last follow-up at 24 months after RRP, 83%, 92.3% and 93.4% of men achieved continence according to definitions 1, 2 and 3, respectively. The difference in time to recovering continence was significant for definition 1 compared to the others (P < 0.001). Most men using 1 pad/day complained of occasional dribbling only (89.3%), considered themselves continent (98%) and their HRQoL was not as seriously affected as those requiring >= 2 pads/day. Men continent (by definition 3) at 2 years had an actuarial probability of preserving continence of 72.2% at the last follow-up. On multivariate analysis the age at surgery (P = 0.009), anastomotic stricture and follow-up interval (both P < 0.001) were independent prognostic factors. Bilateral neurovascular bundle resection was another independent predictive factor (P = 0.03) in the subset of the last 560 men with available data on surgical technique. The reduction in the incidence of incontinence over time was as high as 86%.Conclusions Continence improves progressively until 2 years from RRP but some patients can become incontinent later. The criterion of pad use discriminates well between men with a limited reduction in their QoL (no or one pad used) and those with a markedly affected QoL (>= 2 pads/day). It could be clinically valid to consider users of 1 pad/day as continent. Age, bilateral neurovascular bundle resection and anastomotic stricture are significant risk factors for incontinence. There was a marked trend for the incidence of incontinence and anastomotic stricture to decrease with time.