Nandipati Kalyana C, Raina Rupesh, Agarwal Ashok, Zippe Craig D
Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44125, USA.
Urology. 2007 Dec;70(6):1127-30. doi: 10.1016/j.urology.2007.07.042.
In this long-term prospective study we evaluated the factors affecting urinary continence after radical prostatectomy.
In this study, we recruited 156 patients (mean age, 64.1 +/- 6.7 years; follow-up, 7.8 +/- 1.3 years; prostate-specific antigen [PSA] level, 9.57 +/- 8.81 ng/mL) who underwent radical prostatectomy between 1995 and 1998. Long-term data were obtained on 152 patients, with 4 patients lost to follow-up. Incontinence was evaluated by the number of pads per day. Follow-up data were collected at 3, 6, 12, and 24 months and annually. The multivariate analysis included the following variables: preoperative PSA levels, nerve-sparing (NS) status (bilateral NS, unilateral NS, and non-NS), and age at the time of operation (< or = 65 or > 65 years).
With a mean follow-up of 7.8 +/- 1.3 years, the overall incontinence rate was 17.7% (27 of 152). The incontinence rates were significantly higher in the non-NS group (18 of 61) compared with the bilateral NS group (6 of 66; P <0.05). No significant difference was seen between the unilateral NS and non-NS groups in terms of incontinence rates (P >0.05). When stratified by the NS status, the bilateral NS group had a significant improvement in overall continence. The association between age and incontinence was significant: P <0.05 for patients 65 years or younger (7 of 85) versus those older than 65 years (20 of 67). The association between the preoperative PSA levels and incontinence was not significant but showed a trend (the median PSA in the incontinence group was 8.75 ng/mL; in the continence group it was 5.9 ng/mL; P = 0.0534).
Nerve-sparing radical prostatectomy improves the time interval to regain continence and long-term continence rates.
在这项长期前瞻性研究中，我们评估了影响根治性前列腺切除术后尿失禁的因素。
在本研究中，我们招募了1995年至1998年间接受根治性前列腺切除术的156例患者（平均年龄64.1±6.7岁；随访时间7.8±1.3年；前列腺特异性抗原[PSA]水平9.57±8.81 ng/mL）。获得了152例患者的长期数据，4例患者失访。通过每天使用尿垫的数量评估尿失禁情况。随访数据在3、6、12和24个月以及每年收集。多变量分析包括以下变量：术前PSA水平、神经保留（NS）状态（双侧NS、单侧NS和非NS）以及手术时的年龄（≤65岁或>65岁）。
平均随访7.8±1.3年，总体尿失禁率为17.7%（152例中的27例）。与双侧NS组（66例中的6例）相比，非NS组（61例中的18例）的尿失禁率显著更高（P<0.05）。单侧NS组和非NS组在尿失禁率方面无显著差异（P>0.05）。按NS状态分层时，双侧NS组在总体控尿方面有显著改善。年龄与尿失禁之间的关联显著：65岁及以下患者（85例中的7例）与65岁以上患者（67例中的20例）相比，P<0.05。术前PSA水平与尿失禁之间的关联不显著，但呈一种趋势（尿失禁组的PSA中位数为8.75 ng/mL；控尿组为5.9 ng/mL；P = 0.0534）。
保留神经的根治性前列腺切除术可改善恢复控尿的时间间隔和长期控尿率。
