Lepor Herbert, Kaci Ledia
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
J Urol. 2004 Mar;171(3):1216-9. doi: 10.1097/01.ju.0000113964.68020.a7.
We determined the impact of radical retropubic prostatectomy on continence and lower urinary tract symptoms (LUTS).
Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon, and completed the UCLA Prostate Cancer Index and American Urological Association (AUA) symptom index at baseline, 3, 6, 12 and 24 months after radical prostatectomy. Univariate analysis was performed to identify factors predisposing the early return of continence.
A total of 100%, 98.3%, 97.1%, 94.2% and 98.6% of patients filled out the UCLA Prostate Cancer Index and AUA symptom index at baseline, and 3, 6, 12 and 24 months, respectively. Based on protective pad requirement or frequency of incontinence 100%, 90.9%, 87.2%, 92.1% and 98.5% vs 98.8%, 80.6%, 91.2%, 95.2% and 98.5% of men were continent at baseline, 3, 6, 12 and 24 months after surgery, respectively. Age, severity of lower urinary tract symptoms, Gleason score, nerve sparing status, blood loss or presence of benign prostatic tissue in the apical soft tissue margin did not predict early return of continence. All of the individual urinary symptoms captured by the AUA symptom score showed significant improvement after radical retropubic prostatectomy. Radical prostatectomy was associated with a mean 5.4 unit decrease in AUA symptom score (40% decrease) in men with baseline moderate/severe LUTS (AUA symptom score 8 or greater).
The majority of men regain continence after radical retropubic prostatectomy and maximal continence is achieved by 24 months. No factors were identified that predicted early return of continence in our cohort of men undergoing radical prostatectomy. Radical prostatectomy has a clinically significant impact on improving LUTS.
我们确定了耻骨后根治性前列腺切除术对控尿及下尿路症状（LUTS）的影响。
2000年10月至2002年8月期间，500例临床局限性前列腺癌男性患者由同一位外科医生实施耻骨后根治性前列腺切除术，并在基线期、前列腺癌根治术后3个月、6个月、12个月和24个月完成加州大学洛杉矶分校前列腺癌指数及美国泌尿外科学会（AUA）症状指数评估。进行单因素分析以确定有利于控尿早期恢复的因素。
分别有100%、98.3%、97.1%、94.2%和98.6%的患者在基线期、3个月、6个月、12个月和24个月完成了加州大学洛杉矶分校前列腺癌指数及AUA症状指数评估。根据护垫使用需求或尿失禁频率，分别有100%、90.9%、87.2%、92.1%和98.5%的男性在基线期、术后3个月、6个月、12个月和24个月实现控尿，与之相比，分别为98.8%、80.6%、91.2%、95.2%和98.5%。年龄、下尿路症状严重程度、Gleason评分、保留神经情况、失血量或尖部软组织边缘是否存在良性前列腺组织均不能预测控尿的早期恢复。AUA症状评分所涵盖的所有单项尿路症状在耻骨后根治性前列腺切除术后均有显著改善。对于基线期有中度/重度LUTS（AUA症状评分8分及以上）的男性，根治性前列腺切除术使AUA症状评分平均降低5.4分（降低40%）。
大多数男性在耻骨后根治性前列腺切除术后恢复控尿，术后24个月时实现最大控尿率。在我们这组接受根治性前列腺切除术的男性患者中，未发现可预测控尿早期恢复的因素。根治性前列腺切除术对改善LUTS具有显著的临床影响。
