Chung Doreen E, Dillon Benjamin, Kurta Jordan, Maschino Alexandra, Cronin Angel, Sandhu Jaspreet S
Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; ; Section of Urology, University of Chicago Mount Sinai Hospital, Chicago, IL.
Department of Urology, The Mount Sinai Medical Center, New York, NY;
Can Urol Assoc J. 2013 Jan-Feb;7(1-2):E33-7. doi: 10.5489/cuaj.11038. Epub 2013 Jan 23.
The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.
Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.
Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).
Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
目的是确定根治性前列腺切除术（RP）后出现尿失禁或下尿路症状（LUTS）的患者中逼尿肌活动低下（DU）的患病率及预测因素。我们还确定了该人群中膀胱出口梗阻（BOO）和逼尿肌过度活动（DO）的患病率。
确定接受RP后尿动力学检查的患者。逼尿肌活动低下定义为最大尿流率（Qmax）≤15 mL/s且排尿时逼尿肌压力（Pdet）Qmax <20 cmH₂O或最大Pdet <20 cmH₂O。腹压排尿（AV）定义为排尿期间腹压持续升高。使用艾布拉姆斯-格里菲思列线图和国际尿失禁学会标准确定膀胱出口梗阻和DO。采用单因素逻辑回归确定预测DU的因素。分析了以下因素：年龄、RP年份、手术类型（微创手术[MIS]或开放手术）、术后放疗、神经保留、临床分期、活检Gleason分级以及RP与评估之间的间隔时间。
2005年至2008年期间，264例患者接受了RP后尿动力学检查。108例患者（41%；95%CI 35%，47%）出现逼尿肌活动低下，其中48%表现为AV。总体而言，BOO和DO的患病率分别为17%（95%CI 12%，22%）和27%（95%CI 22%，33%）。单因素分析显示，只有MIS RP可预测DU（MIS与开放手术相比，单因素比值比为2.05；p = 0.009）。
RP后因尿失禁或LUTS前来评估的患者中，逼尿肌活动低下和AV很常见。这种情况下DU的病因可能与手术方式有关。由于DU可能影响男性吊带或人工尿道括约肌治疗男性尿失禁的成功率，因此在治疗前记录其存在情况很有用。需要更多研究来阐明DU对RP后男性尿失禁治疗成功率的影响。
