Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
Urology. 2010 Feb;75(2):431-6. doi: 10.1016/j.urology.2009.07.1294. Epub 2009 Oct 24.
To propose a strict and specific definition of continence (leak-free and pad-free [LFPF]) and apply it to robot-assisted radical prostatectomy (RARP) outcomes on the basis of University of California-Los Angeles-Prostate Cancer Index (UCLA-PCI), as postprostatectomy incontinence is not well defined.
A single-institution RARP database was reviewed concerning continence variables prospectively recorded by the UCLA-PCI. Specific responses to urinary function and continence items were reviewed at baseline and 1, 3, 6, 12, and 24 months after surgery.
From February 2003 to September 2007, a total of 1005 of 1500 RARP patients had data available for review. At baseline, only 73% of these patients were LFPF. This decreased to 4%, 9%, 17%, 24%, and 28% at 1, 3, 6, 12, and 24 months after surgery, respectively. Applying less strict definitions, at 24 months, 68% of patients reported no pad use and 90% of patients reported no pad use or the use of a security pad. When stratified by baseline LFPF status, patients not LFPF at baseline had higher baseline international prostate symptom score scores, lower urinary function scores, lower urinary bother scores, and larger prostate weights. Patients LFPF at baseline disproportionately regained LFPF continence starting 6 months after surgery compared with those not LFPF at baseline: 20% vs 9% (P = .005), 27% vs 15% (P = .0009), and 33% vs 15% (P = .0146) at 6, 12, and 24 months, respectively.
A strict definition of urinary continence results in more conservative postoperative outcomes. Preoperative LFPF status can be predictive of postoperative LFPF continence. However, only one-third of patients LFPF at baseline returned to LFPF at 24 months.
提出一个严格和具体的控尿定义（无漏尿且无尿垫[LFPF]），并基于加利福尼亚大学洛杉矶前列腺癌指数（UCLA-PCI）将其应用于机器人辅助前列腺癌根治术（RARP）的结果，因为前列腺切除术后尿失禁的定义并不明确。
对单机构 RARP 数据库进行了回顾性研究，该数据库中前瞻性地记录了由 UCLA-PCI 记录的控尿变量。在手术前后 1、3、6、12 和 24 个月时，对尿功能和控尿项目的具体反应进行了回顾。
从 2003 年 2 月至 2007 年 9 月，共有 1500 例 RARP 患者中的 1005 例有数据可供审查。在基线时，这些患者中只有 73%为 LFPF。这一比例分别在手术后 1、3、6、12 和 24 个月时降至 4%、9%、17%、24%和 28%。应用较不严格的定义，在 24 个月时，68%的患者报告无尿垫使用，90%的患者报告无尿垫或使用安全垫。按基线 LFPF 状态分层，基线时非 LFPF 的患者国际前列腺症状评分较高，尿功能评分较低，排尿困扰评分较高，前列腺重量较大。与基线时非 LFPF 的患者相比，基线时 LFPF 的患者在术后 6 个月后更有可能恢复 LFPF 控尿：20%比 9%（P=0.005），27%比 15%（P=0.0009），33%比 15%（P=0.0146），分别在 6、12 和 24 个月时。
严格的尿控定义会导致更保守的术后结果。术前 LFPF 状态可预测术后 LFPF 控尿情况。然而，只有三分之一的基线 LFPF 患者在 24 个月时恢复到 LFPF。
