Department of Regional Urology, Cleveland Clinic Fairview Cancer Center, Glickman Urological and Kidney Institute, Cleveland, OH 44111, USA.
Urology. 2010 Feb;75(2):482-6. doi: 10.1016/j.urology.2009.07.1282. Epub 2009 Oct 24.
To identify possible correlations of thermocouple recorded data with altered postoperative voiding function after prostate cryosurgery.
A retrospective analysis of the records of 58 patients treated with prostate cryoablation from October 2005 through April 2009 was conducted. Multivariate analysis of patient age, presenting prostate-specific antigen level, Gleason score, clinical T stage, prostate volume, maximum low temperature thermocouple recordings, history of radiation and or hormonal therapy, were studied as possible correlative factors for altered postoperative voiding function.
Of 58 patients, 22 (37.9%) manifested postcryoablation urgency and frequency (n = 13) requiring medical therapy or retention (n = 9). On multivariate analysis, age (P = .037) and an external sphincter temperature < or = 23 degrees C (P = .012) were associated with voiding frequency, urgency, or retention (odds ratio = 6.26, 95% CI: 1.62-24.16), whereas anterior rectal wall temperature (Denon) was weakly associated (P = .079).
Thermocouple data provide an objective means of assessing cryosurgical outcomes. This is the first report of a correlation of such data to post-treatment voiding function. A total of 37.9% of patients experienced urgency and/or frequency or urinary retention after cryoablation of the prostate for localized disease. Older age and external sphincter temperature < or = 23 degrees C were statistically significant predictors of these events. The data suggest that limiting the degree of freezing at the external sphincter may decrease procedure related morbidity. Further study is warranted to better delineate temperature-related data on treatment outcomes.
确定热电偶记录数据与前列腺冷冻手术后排尿功能改变的可能相关性。
对 2005 年 10 月至 2009 年 4 月接受前列腺冷冻消融治疗的 58 例患者的记录进行回顾性分析。对患者年龄、前列腺特异性抗原水平、Gleason 评分、临床 T 分期、前列腺体积、最大低温热电偶记录、放疗和/或激素治疗史等多变量分析，作为术后排尿功能改变的可能相关因素。
58 例患者中，22 例（37.9%）术后出现冷冻消融后急迫性和频发性尿失禁（n=13），需要药物治疗或留置导尿（n=9）。多变量分析显示，年龄（P=0.037）和外部括约肌温度<或=23°C（P=0.012）与排尿频率、急迫性或留置导尿相关（比值比=6.26，95%可信区间：1.62-24.16），而直肠前壁温度（Denon）则呈弱相关（P=0.079）。
热电偶数据提供了一种评估冷冻手术结果的客观方法。这是首次报道这种数据与治疗后排尿功能的相关性。在对局限性前列腺疾病进行冷冻消融后，37.9%的患者出现急迫性和/或频发性尿失禁或尿潴留。年龄较大和外部括约肌温度<或=23°C是这些事件的统计学显著预测因素。数据表明，限制外部括约肌的冷冻程度可能会降低与手术相关的发病率。需要进一步研究以更好地确定与温度相关的治疗结果数据。
