Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Int J Urol. 2011 Oct;18(10):700-8. doi: 10.1111/j.1442-2042.2011.02826.x. Epub 2011 Aug 11.
To assess the factors associated with continence recovery 1 month after radical prostatectomy (RP) and to identify the correlation between these factors.
In total, 2408 men treated with RP for prostate cancer (PCa) were enrolled in the present multicenter prospective study. Clinical (age, body mass index) and urological (catheterization or transurethral resection of the prostate) records, quality of life (QOL) scores determined using various instruments (including the International Index of Erectile Function [IIEF] and University of California Los Angeles, Prostate Cancer Index [UCLA-PCI]), PCa characteristics (clinical stage [cT], prostate-specific antigen, biopsy Gleason score), surgical features (surgical approach, nerve and bladder neck sparing, catheterization), and pathologic outcomes (pT, pN+, Gleason score, positive surgical margins) were recorded. Continence status prior to surgery and at 1 month after RP was assessed and classified as followed: (i) full continence; (ii) 0-1 pads/day; or (iii) >1 pad/day. Only patients determined to have full continence prior to surgery were included in the analysis. Data were evaluated using Spearman's correlation analysis and multivariate logistic regression.
Data from 1972 patients with full continence preoperatively and complete postoperative data were analyzed. At 1 month after RP, 644 patients (32.7%) were fully continent, 810 (41.1%) were using 0-1 pads/day, and 518 (26.3%) were using >1 pad/day. Univariate analysis indicated that clinical and urological data, QOL, PCa characteristics, surgical features, and pathologic outcomes were determinants for continence recovery. Multivariate analysis indicated that preoperative sexual activity (UCLA-PCI Sexual Function P = 0.005; IIEF P = 0.040), bladder neck sparing (P = 0.003), catheterization time (P = 0.007), and catheter diameter (P = 0.046) were associated with 1 month continence recovery.
Age and nerve sparing are not significant predictors of continence recovery 1 month after RP. Preoperative erectile function can predict post-prostatectomy incontinence. Bladder neck preservation has a significant effect on early continence recovery after RP.
评估根治性前列腺切除术（RP）后 1 个月尿控恢复的相关因素，并确定这些因素之间的相关性。
本研究共纳入 2408 例接受 RP 治疗的前列腺癌（PCa）患者。临床（年龄、体重指数）和泌尿科（置管或经尿道前列腺切除术）记录、使用各种工具（包括国际勃起功能指数[IIEF]和加利福尼亚大学洛杉矶分校前列腺癌指数[UCLA-PCI]）确定的生活质量（QOL）评分、PCa 特征（临床分期[cT]、前列腺特异性抗原、活检 Gleason 评分）、手术特征（手术方法、神经和膀胱颈保留、置管）和病理结果（pT、pN+、Gleason 评分、阳性切缘）均被记录。术前和 RP 后 1 个月的控尿状态进行评估和分类如下：（i）完全控尿；（ii）0-1 片/天；或（iii）>1 片/天。仅纳入术前确定完全控尿的患者进行分析。使用 Spearman 相关分析和多变量逻辑回归对数据进行评估。
对 1972 例术前完全控尿且术后资料完整的患者进行了数据分析。在 RP 后 1 个月时，644 例（32.7%）患者完全控尿，810 例（41.1%）患者使用 0-1 片/天，518 例（26.3%）患者使用>1 片/天。单因素分析表明，临床和泌尿科数据、QOL、PCa 特征、手术特征和病理结果是控尿恢复的决定因素。多因素分析表明，术前性行为（UCLA-PCI 性功能 P = 0.005；IIEF P = 0.040）、膀胱颈保留（P = 0.003）、置管时间（P = 0.007）和导管直径（P = 0.046）与 1 个月控尿恢复相关。
年龄和神经保留不是 RP 后 1 个月控尿恢复的显著预测因素。术前勃起功能可预测前列腺切除术后尿失禁。膀胱颈保留对 RP 后早期控尿恢复有显著影响。
