Kielb S, Dunn R L, Rashid M G, Murray S, Sanda M G, Montie J E, Wei J T
Departments of Urology/Surgery, University of Michigan, Ann Arbor, MI, USA.
J Urol. 2001 Sep;166(3):958-61.
Patients considering radical prostatectomy often inquire as to when they can expect to regain urinary continence. However, there is a paucity of patient self-reported data regarding the recovery of continence during the initial 3 months after surgery. Our objectives were to assess urinary continence changes early in the postoperative period and determine which of 2 commonly used definitions of continence more closely relate to patient reported urinary impairment.
A prospective study of 90 men with clinically localized prostate cancer who selected radical prostatectomy as primary therapy was conducted. Repeated measures of urinary continence as defined by 1) total urinary control, 2) the use of 1 or 0 pads daily, and 3) small or no problem with urinary function were obtained with a brief survey preoperatively and postoperatively.
At 56 days after removal of urethral catheters, the actuarial rates of urinary continence recovery based on definitions 1 to 3 were 43%, 84% and 82%, respectively. The use of definition 2 for continence resulted in a 1.9 times higher actuarial rate for continence recovery when compared to definition 1 at 56 days (p <0.001). However, strong agreement was observed between definitions 2 and 3 (kappa = 0.69).
Urinary control is recovered in a significant proportion of men who undergo radical prostatectomy during the initial 3 months. Continence rates will vary significantly based on the use of alternative definitions. The clinical practice of asking patients how many pads daily they use may be valid, as it corresponds well to the impairment they have.
考虑接受根治性前列腺切除术的患者常常询问他们何时有望恢复尿失禁。然而，关于术后最初3个月内尿失禁恢复情况的患者自我报告数据较少。我们的目标是评估术后早期尿失禁的变化，并确定两种常用的尿失禁定义中哪一种与患者报告的排尿功能障碍更密切相关。
对90例临床局限性前列腺癌患者进行了一项前瞻性研究，这些患者选择根治性前列腺切除术作为主要治疗方法。通过术前和术后的简短调查，获得了根据以下定义的尿失禁重复测量数据：1）完全排尿控制；2）每天使用1片或0片尿垫；3）排尿功能问题小或无问题。
拔除尿道导管后56天，根据定义1至3的尿失禁恢复精算率分别为43%、84%和82%。与定义1相比，在56天时使用定义2的尿失禁恢复精算率高出1.9倍（p<0.001）。然而，定义2和定义3之间观察到高度一致性（kappa=0.69）。
在最初3个月内接受根治性前列腺切除术的男性中，很大一部分人恢复了排尿控制。根据不同定义，尿失禁发生率会有显著差异。询问患者每天使用多少片尿垫的临床实践可能是有效的，因为它与他们的功能障碍情况非常相符。
