Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy.
Int J Urol. 2013 Apr;20(4):413-9. doi: 10.1111/j.1442-2042.2012.03149.x. Epub 2012 Sep 12.
To investigate the effect of phosphodiesterase type 5 inhibitor on urinary continence recovery after bilateral nerve-sparing radical prostatectomy.
We analyzed data of 393 open bilateral nerve-sparing radical prostatectomies carried out between 2005 and 2010. Patients who recovered urinary continence within the first month after catheter removal (n = 52) were excluded. This resulted in 341 evaluable patients. Urinary continence recovery was defined as being completely pad free over a period of 24 h. Patients were stratified according to postoperative daily (n = 58; 17%), on-demand (n = 112; 32.8%) and no (n = 171; 50.1%) phosphodiesterase type 5 inhibitor use. The effect of phosphodiesterase type 5 inhibitor use on urinary continence was assessed using the Kaplan-Meier method. Uni- and multivariable Cox regression analyses were used to test the association between phosphodiesterase type 5 inhibitor and urinary continence recovery after adjusting for cofounders.
At a mean follow up of 36.4 months after surgery (median: 33), 288 patients (84.5%) recovered urinary continence after bilateral nerve-sparing radical prostatectomy. Patients who did not use phosphodiesterase type 5 inhibitor after surgery had lower rates of urinary continence recovery at 1- and 2-year follow up as compared with patients taking phosphodiesterase type 5 inhibitor (67.1 vs 86.7% and 76 vs 94.4%, respectively; P < 0.001). After adjusting for all confounders, multivariable analysis showed that phosphodiesterase type 5 inhibitor use, either on demand or daily, had a positive impact on urinary continence recovery (P = 0.03).
Patients taking phosphodiesterase type 5 inhibitor have higher urinary continence recovery rates as compared with patients left untreated after bilateral nerve-sparing radical prostatectomy. An improvement in sphincteric and pelvic floor blood supply might be responsible for this beneficial effect associated with the use of phosphodiesterase type 5 inhibitor.
探讨磷酸二酯酶 5 型抑制剂对双侧保留神经根治性前列腺切除术后尿控恢复的影响。
我们分析了 2005 年至 2010 年间进行的 393 例开放双侧保留神经根治性前列腺切除术的数据。排除术后 1 个月内拔除导管后恢复尿控的患者（n=52）。这导致 341 例可评估患者。尿控恢复定义为在 24 小时内完全无垫。根据术后每日（n=58；17%）、按需（n=112；32.8%）和无（n=171；50.1%）使用磷酸二酯酶 5 型抑制剂，对患者进行分层。使用 Kaplan-Meier 方法评估磷酸二酯酶 5 型抑制剂使用对尿控的影响。使用单变量和多变量 Cox 回归分析，在调整混杂因素后，测试磷酸二酯酶 5 型抑制剂与双侧保留神经根治性前列腺切除术后尿控恢复之间的关系。
术后平均随访 36.4 个月（中位数：33 个月），288 例（84.5%）患者在双侧保留神经根治性前列腺切除术后恢复尿控。与术后使用磷酸二酯酶 5 型抑制剂的患者相比，未使用磷酸二酯酶 5 型抑制剂的患者在 1 年和 2 年随访时尿控恢复率较低（分别为 67.1%比 86.7%和 76%比 94.4%；P<0.001）。在调整所有混杂因素后，多变量分析显示，按需或每日使用磷酸二酯酶 5 型抑制剂对尿控恢复有积极影响（P=0.03）。
与双侧保留神经根治性前列腺切除术后未治疗的患者相比，使用磷酸二酯酶 5 型抑制剂的患者尿控恢复率更高。磷酸二酯酶 5 型抑制剂的使用可能改善尿道括约肌和盆底的血液供应，从而产生这种有益的效果。
