Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.
J Urol. 2010 Mar;183(3):1087-91. doi: 10.1016/j.juro.2009.11.033. Epub 2010 Jan 21.
We evaluated the effect of diabetes mellitus on incontinence after laparoscopic radical prostatectomy.
From a series of 2,071 patients 135 with type 2 diabetes mellitus undergoing laparoscopic radical prostatectomy without radiotherapy and with a minimum followup of 24 months were identified. These patients were randomly matched with 135 nondiabetic controls for age, body mass index, preoperative prostate specific antigen, clinical stage, neoadjuvant hormonal therapy, prostate volume, previous surgery, surgeon skills, surgical approach, presence of bladder neck sparing, lymphadenectomy, technique of urethrovesical anastomosis and attempted nerve sparing surgery.
Using multivariate analysis age, diabetes mellitus and duration of diabetes mellitus were independent factors for post-prostatectomy incontinence in the whole group. Early continence (0 to 3 months) was observed in 43.7% of patients with diabetes and in 57.8% of nondiabetic controls which was statistically significant (p = 0.02). The rates of continence in patients with diabetes mellitus for 5 or more years at 3, 12 and 24-month evaluations were less than those in patients with diabetes mellitus for less than 5 years, and the difference was statistically significant (36% vs 50%, p = 0.001; 63.9% vs 82.4%, p = 0.02; 91.8% vs 98.6%, p = 0.03, respectively).
Patients with type 2 diabetes mellitus need longer to recover continence than nondiabetics after laparoscopic radical prostatectomy. However, type II diabetes mellitus did not affect overall return to continence. Patients with diabetes mellitus for 5 or more years have an almost 5 times increased risk of post-prostatectomy incontinence compared to those with diabetes mellitus for less than 5 years. Diabetic patients should be counseled for the potential negative impact of diabetes mellitus on the recovery of continence after laparoscopic radical prostatectomy.
我们评估了 2 型糖尿病对腹腔镜根治性前列腺切除术后尿失禁的影响。
从 2071 例接受腹腔镜根治性前列腺切除术且无放疗、随访时间至少 24 个月的患者中，确定了 135 例 2 型糖尿病患者。这些患者与 135 例非糖尿病对照组随机匹配，比较年龄、体重指数、术前前列腺特异抗原、临床分期、新辅助激素治疗、前列腺体积、既往手术、手术医生技能、手术途径、膀胱颈部保留、淋巴结清扫、尿道膀胱吻合技术和尝试保留神经手术。
多因素分析显示，年龄、糖尿病和糖尿病病程是全组患者前列腺切除术后尿失禁的独立因素。糖尿病组患者术后 0 至 3 个月的早期尿控率为 43.7%，非糖尿病对照组为 57.8%，差异有统计学意义（p = 0.02）。糖尿病病程超过 5 年的患者在 3、12 和 24 个月评估时的尿控率低于病程小于 5 年的患者，差异有统计学意义（36%比 50%，p = 0.001；63.9%比 82.4%，p = 0.02；91.8%比 98.6%，p = 0.03）。
与非糖尿病患者相比，2 型糖尿病患者行腹腔镜根治性前列腺切除术后恢复尿控需要更长的时间。然而，2 型糖尿病并不影响整体恢复尿控。病程超过 5 年的糖尿病患者术后尿失禁的风险比病程小于 5 年的患者增加近 5 倍。糖尿病患者应被告知糖尿病对腹腔镜根治性前列腺切除术后尿控恢复的潜在负面影响。
