Glickman Leonard, Godoy Guilherme, Lepor Herbert
Department of Urology, Division of Urologic Oncology, New York University School of Medicine, New York, New York 10016, USA.
J Urol. 2009 Feb;181(2):731-5. doi: 10.1016/j.juro.2008.10.019. Epub 2008 Dec 16.
There is a paucity of information on changes in continence and erectile function beyond 2 years after radical prostatectomy. We prospectively examined changes in continence and erectile function between 2 and 4 years after radical prostatectomy.
Between October 2000 and August 2003, 731 consecutive men underwent open retropubic radical prostatectomy for clinically localized prostate cancer. Preoperative and postoperative continence, and erectile function were ascertained using the UCLA Prostate Cancer Index. The 48-month prospective self-assessment followup questionnaire captured changes in urinary control and erectile function between 24 and 48 months, including marked, moderate or slight improvement, no change or worsening.
Overall between 24 and 48 months after radical prostatectomy 23.4% and 42.3% of men showed any degree of improvement in continence and erectile function, and 12.2% and 19.8% showed marked and moderate improvement in continence and erectile function, respectively. The probability of experiencing any qualitative improvement in urinary continence was not significantly different in men who were continent or incontinent at 24 months. The likelihood of experiencing any qualitative improvement in erectile function was significantly greater in men who were potent at 24 months compared to those who were impotent.
Our study provides compelling evidence that clinically significant improvements in urinary control and erectile function occur beyond 2 years after radical prostatectomy. These qualitative improvements are greatest for erectile function in men who were potent at 2 years. Therefore, men should not be counseled that maximal urinary continence or erectile function are achieved by 24 months after radical prostatectomy.
关于根治性前列腺切除术后2年以上尿失禁和勃起功能变化的信息较少。我们前瞻性地研究了根治性前列腺切除术后2至4年尿失禁和勃起功能的变化。
2000年10月至2003年8月期间，731例连续男性因临床局限性前列腺癌接受开放性耻骨后根治性前列腺切除术。使用加州大学洛杉矶分校前列腺癌指数确定术前和术后的尿失禁及勃起功能。48个月的前瞻性自我评估随访问卷记录了24至48个月期间尿控和勃起功能的变化，包括明显改善、中度改善或轻微改善、无变化或恶化。
根治性前列腺切除术后24至48个月，总体上分别有23.4%和42.3%的男性尿失禁和勃起功能有任何程度的改善，分别有12.2%和19.8%的男性尿失禁和勃起功能有明显和中度改善。在24个月时尿失禁或未尿失禁的男性中，尿失禁出现任何质性改善的概率无显著差异。与24个月时勃起功能障碍的男性相比，24个月时勃起功能正常的男性勃起功能出现任何质性改善的可能性显著更高。
我们的研究提供了令人信服的证据，表明根治性前列腺切除术后2年以上尿控和勃起功能有临床上显著的改善。这些质性改善在2年时勃起功能正常的男性中对勃起功能最为明显。因此，不应告知男性根治性前列腺切除术后24个月即可实现最大程度的尿失禁控制或勃起功能。
