Campodonico Fabio, Manuputty Egi Edward, Campora Sara, Puntoni Matteo, Maffezzini Massimo
Urology Unit, Galliera Hospital, Genova, Italy.
Urol Int. 2014;92(3):276-81. doi: 10.1159/000353414. Epub 2013 Oct 19.
Immediate continence is a goal to take into consideration for better patient satisfaction after radical prostatectomy. Factors predicting urinary continence at catheter removal were investigated.
We evaluated preoperative, operative, clinical, hormonal and pathological variables in a homogeneous series of radical retropubic prostatectomies (RRPs) following the principles of urinary sphincter restoration technique.
The study included 201 patients who underwent RRP. The overall immediate continence rate at catheter removal was 67.7% (136 patients); 28.8% (58 patients) were using one protective pad daily and 3.5% (7 patients) were incontinent. At 6-month follow-up incontinence had reached the lowest level of 2.5% (5 patients) and at 12 months the patients using one pad daily had decreased to 11.9% (24 patients). Multivariate logistic analysis showed that the only two factors independently associated with immediate continence were age <65 years (OR = 2.63, 95% CI 1.13-5.88, p = 0.02) and potency (OR = 3.6, 95% CI 1.2-10.7, p = 0.01) adjusting for D'Amico risk group, surgical margins, extracapsular extension, clinical stage, PSA, testosterone, LH and FSH. No significant association was noted for PSA, hormonal levels, hospital stay, prostate size, clinical stage, risk group, TNM stage, pathological Gleason score or extracapsular extension.
In our series age <65 years was associated with immediate continence after RRP. Moreover, patients who were immediately continent had a 3.6-fold probability to be potent within 12 months.
即刻控尿是根治性前列腺切除术后提高患者满意度需考虑的一个目标。我们对拔除导尿管时预测尿控的因素进行了研究。
我们按照尿道括约肌修复技术的原则，对一系列同质的耻骨后根治性前列腺切除术（RRP）患者的术前、手术、临床、激素及病理变量进行了评估。
该研究纳入了201例行RRP的患者。拔除导尿管时的总体即刻控尿率为67.7%（136例患者）；28.8%（58例患者）每天使用一片护垫，3.5%（7例患者）存在尿失禁。在6个月随访时，尿失禁率降至最低水平2.5%（5例患者），在12个月时，每天使用一片护垫的患者降至11.9%（24例患者）。多因素逻辑分析显示，在对达米科风险组、手术切缘、包膜外侵犯、临床分期、前列腺特异性抗原（PSA）、睾酮、促黄体生成素（LH）和促卵泡生成素（FSH）进行校正后，与即刻控尿独立相关的仅两个因素为年龄<65岁（比值比[OR]=2.63，95%可信区间[CI]1.13 - 5.88，p = 0.02）和性功能（OR = 3.6，95%CI 1.2 - 10.7，p = 0.01）。未发现PSA、激素水平、住院时间、前列腺大小、临床分期、风险组、TNM分期、病理格里森评分或包膜外侵犯存在显著相关性。
在我们的研究系列中，年龄<65岁与RRP术后的即刻控尿相关。此外，即刻控尿的患者在12个月内保持性功能的可能性为3.6倍。
