保留神经手术对前列腺癌根治术后患者报告的控尿功能的影响。
The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy.
作者信息
Toren Paul, Alibhai Shabbir M H, Matthew Andre, Nesbitt Michael, Kalnin Robin, Fleshner Neil, Trachtenberg John
机构信息
Department of Surgery, University of Toronto;
出版信息
Can Urol Assoc J. 2009 Dec;3(6):465-70. doi: 10.5489/cuaj.1176.
INTRODUCTION
Urinary continence significantly affects quality of life after radical prostatectomy (RP). The impact of nerve-sparing surgery on continence is unclear from the current literature.
METHODS
We identified men with prostate cancer from the University Health Network Prostate Centre database who underwent RP. Preoperatively and at each postoperative visit, patients completed the Patient-Oriented Prostate Utility Scale (PORPUS), a validated psychometric and health utility instrument. Incontinence was defined by a single questionnaire item. Patients with radiotherapy or less than 10 months follow-up were excluded. Chi-squared tests and ANOVA were used to compare groups. Multivariable logistic regression was used to control for effects of nerve-sparing and other covariates.
RESULTS
Of the 253 eligible patients from 2003 to 2007, 159 patients had bilateral nerve-sparing, 32 had unilateral nerve-sparing and 62 had non-nerve-sparing surgery. Of these patients, 27%, 17% and 34%, respectively, were classified as incontinent at 1 year. These proportions were not significantly different between groups (p = 0.23). Multivariable logistic regression showed baseline urinary continence and urinary frequency to be significant predictors of patient-reported continence at 1 year postoperatively, with odds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5 (95% CI 1.0-2.3), respectively. There was a significant difference in the proportion of PORPUS sexual function scores between nerve-sparing groups after excluding those with baseline sexual dysfunction (p = 0.003). Similarly, health-related utility scores were different across groups (p < 0.001).
CONCLUSION
Our results do not suggest a difference in 1-year patient-reported continence based on the type of nerve-sparing RP. However, baseline continence and urinary frequency were significant predictors of continence at 1 year.
引言
尿失禁对前列腺癌根治术（RP）后的生活质量有显著影响。目前文献中，保留神经手术对尿失禁的影响尚不清楚。
方法
我们从大学健康网络前列腺中心数据库中识别出接受RP的前列腺癌男性患者。术前及术后每次随访时，患者完成以患者为导向的前列腺效用量表（PORPUS），这是一种经过验证的心理测量和健康效用工具。尿失禁由单个问卷项目定义。排除接受放疗或随访时间少于10个月的患者。采用卡方检验和方差分析比较组间差异。使用多变量逻辑回归来控制保留神经及其他协变量的影响。
结果
在2003年至2007年的253例符合条件的患者中，159例患者接受双侧神经保留手术，32例接受单侧神经保留手术，62例接受非神经保留手术。这些患者中，1年后分别有27%、17%和34%被归类为尿失禁。组间这些比例无显著差异（p = 0.23）。多变量逻辑回归显示，基线尿失禁和尿频是术后1年患者报告的尿失禁的显著预测因素，优势比分别为1.7（95%置信区间[CI] 1.1 - 2.9）和1.5（95% CI 1.0 - 2.3）。排除基线性功能障碍患者后，保留神经组间PORPUS性功能评分比例存在显著差异（p = 0.003）。同样，各健康相关效用评分在组间也不同（p < 0.001）。
结论
我们的结果并不表明基于保留神经的RP类型，患者报告的1年尿失禁情况存在差异。然而，基线尿失禁和尿频是1年时尿失禁的显著预测因素。
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