Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.
BJU Int. 2011 Nov;108(10):1572-7. doi: 10.1111/j.1464-410X.2011.10231.x. Epub 2011 May 19.
To identify predictors for long-term urinary leakage after radical prostatectomy.
A consecutive series of 1411 patients who underwent radical prostatectomy (open surgery or robot-assisted laparoscopic surgery) at Karolinska University Hospital between 2002 and 2006 were invited to complete a study-specific questionnaire. Urinary leakage was defined as use of two or more pads per day.
Questionnaires were received from 1288 (91%) patients with a median follow-up of 2.2 years. Age at surgery predicts in an exponential manner long-term urinary incontinence at follow-up with an estimated relative increase of 6% per year. Among the oldest patients, 19% had urinary incontinence compared with 6% in the youngest age group, translating to a prevalence ratio of 2.4 (95% confidence interval [CI], 1.5-8.1). Low educational level, as compared with high, yielded an increased age-adjusted prevalence ratio of 2.5 (95% CI, 1.7-3.9). Patients who had undergone salvage radiation therapy had an increased prevalence of urinary incontinence (2.5; 95% CI, 1.6-3.8), as did those with respiratory disease (2.4; 95% CI, 1.3-4.4). Body mass index, prostate weight, presence of diabetes or previous transurethral resection did not appear to influence the prevalence of urinary incontinence.
In this series, a patient's age at radical prostatectomy influenced, in an exponential manner, his risk of long-term urinary incontinence. Other predictors are low educational level, salvage radiation therapy and respiratory disease. Intervention studies are needed to understand if these data are relevant to the prevalence of urinary leakage if a radical prostatectomy is postponed in an active monitoring programme.
确定根治性前列腺切除术后长期尿失禁的预测因素。
2002 年至 2006 年间，在卡罗林斯卡大学医院接受根治性前列腺切除术（开放性手术或机器人辅助腹腔镜手术）的 1411 例连续患者被邀请完成一项特定的研究问卷。尿失禁定义为每天使用两片或两片以上的尿垫。
共收到 1288 名（91%）患者的问卷，中位随访时间为 2.2 年。手术时的年龄以指数方式预测随访时的长期尿失禁，估计每年相对增加 6%。在最年长的患者中，19%有尿失禁，而最年轻年龄组的 6%，这意味着流行率比为 2.4（95%置信区间[CI]，1.5-8.1）。与高学历相比，低学历的患者调整后的流行率比增加了 2.5（95% CI，1.7-3.9）。接受挽救性放射治疗的患者尿失禁的流行率增加（2.5；95% CI，1.6-3.8），有呼吸系统疾病的患者也是如此（2.4；95% CI，1.3-4.4）。体重指数、前列腺重量、糖尿病或既往经尿道切除术似乎并不影响尿失禁的流行率。
在本系列中，患者根治性前列腺切除术时的年龄以指数方式影响其长期尿失禁的风险。其他预测因素包括低教育水平、挽救性放射治疗和呼吸系统疾病。需要进行干预研究，以了解如果在主动监测计划中延迟根治性前列腺切除术，这些数据是否与尿失禁的流行率相关。
