Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
BJU Int. 2013 May;111(6):905-13. doi: 10.1111/j.1464-410X.2012.11560.x. Epub 2013 Jan 17.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urinary incontinence is one of the most important morbidities after radical prostatectomy that has detrimental effect on the postoperative quality of life. The present study provides an accurate and dynamic multivariable risk stratification tool that predicts the postoperative urinary incontinence risk after radical prostatectomy based on patient-related as well as surgeon-related variables.
To develop a multivariable risk classification tool to estimate postoperative urinary incontinence (UI) risk as UI represents one of the most disabling surgical sequelae after radical prostatectomy (RP).
We evaluated 1311 patients treated with nerve-sparing RP between 2006 and 2010 at our institution. Regression tree analysis was used to stratify patients according to their postoperative UI risk. Kaplan-Meier curve estimates were used to assess the UI rate in the novel UI-risk groups. The discrimination of the novel tool was measured with the area under the curve method.
At 3, 6 and 12 months, the UI rates were 44%, 26% and 12%, respectively. Regression tree analysis stratified patients into high risk (International Index of Erectile Function - Erectile Function domain [IIEF-EF] = 1-10), intermediate risk (IIEF-EF > 10 and age ≥ 65 years), low risk (IIEF-EF > 10, age < 65 years and body mass index [BMI] ≥ 25 kg/m(2) ) and very low risk (IIEF-EF > 10, age < 65 years and BMI < 25 kg/m(2) ) groups. The 3-month UI rates in these groups were 37%, 43%, 45% and 48%, respectively. The 6-month UI rates were 19%, 23%, 29% and 34%, respectively. The 12-month UI rates were 7%, 13%, 14% and 15%, respectively (log-rank P < 0.001). The area under the curve was 71%, 70% and 68% at 3, 6 and 12 months, respectively.
We developed the first risk classification tool that predicts patients at high risk of UI after RP. These consisted mainly of individuals who were impotent before RP, elderly and/or overweight. This tool can be used for patient counselling.
尿失禁是根治性前列腺切除术后最重要的并发症之一，对术后生活质量有不利影响。本研究提供了一种准确和动态的多变量风险分层工具，基于患者相关和外科医生相关变量预测根治性前列腺切除术后尿失禁的风险。
开发一种多变量风险分类工具，以估计术后尿失禁（UI）的风险，因为 UI 是根治性前列腺切除术（RP）后最具致残性的手术后遗症之一。
我们评估了 2006 年至 2010 年在我们机构接受神经保留 RP 治疗的 1311 例患者。回归树分析用于根据患者术后 UI 风险对患者进行分层。Kaplan-Meier 曲线估计用于评估新 UI 风险组中的 UI 发生率。通过曲线下面积方法测量新工具的区分度。
在 3、6 和 12 个月时，UI 发生率分别为 44%、26%和 12%。回归树分析将患者分为高危组（国际勃起功能指数-勃起功能域 [IIEF-EF] = 1-10）、中危组（IIEF-EF > 10 岁且年龄≥65 岁）、低危组（IIEF-EF > 10 岁且年龄<65 岁和体重指数 [BMI]≥25 kg/m2）和极低危组（IIEF-EF > 10 岁且年龄<65 岁和 BMI<25 kg/m2）。这些组的 3 个月 UI 发生率分别为 37%、43%、45%和 48%。6 个月的 UI 发生率分别为 19%、23%、29%和 34%。12 个月的 UI 发生率分别为 7%、13%、14%和 15%（对数秩 P<0.001）。曲线下面积分别为 3、6 和 12 个月时的 71%、70%和 68%。
我们开发了第一个预测 RP 后尿失禁风险较高的患者的风险分类工具。这些主要包括术前勃起功能障碍、年龄较大和/或超重的患者。该工具可用于患者咨询。
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