Lee Chan Ho, Ha Hong Koo
Department of Urology, Pusan National University School of Medicine; Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Int J Urol. 2014 Jul;21(7):653-6. doi: 10.1111/iju.12419. Epub 2014 Mar 27.
To evaluate the significance of intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy.
A total of 242 patients who underwent laparoscopic radical prostatectomy were included in the study. Data on incontinence status and the number of pads required per day for urinary incontinence were collected. Urinary continence was defined as no pad use or occasional security pad use. Intravesical prostatic protrusion was measured by the vertical distance from the tip of the protruding prostate to the base of the urinary bladder in the sagittal plane of preoperative magnetic resonance imaging. Continence at 1, 3, 6 and 12 months postoperatively was assessed by dividing the patients into two groups based on the degree of intravesical prostatic protrusion. The correlation between preoperative factors and urinary continence after laparoscopic radical prostatectomy was examined.
The urinary continence rates at postoperative month 1, 3, 6 and 12 were 19%, 50%, 79.8% and 92.1%, respectively. In the multivariate logistic analysis, intravesical prostatic protrusion was a significant independent predictive factor of early urinary continence at 1, 3, 6, 9 and 12 months. Markedly improved urinary continence was observed in the non-significant intravesical prostatic protrusion group (intravesical prostatic protrusion <5 mm) at all periods compared with the significant intravesical prostatic protrusion group (intravesical prostatic protrusion ≥5 mm; P < 0.05).
These findings suggest that the likelihood of postoperative urinary incontinence in patients undergoing laparoscopic radical prostatectomy is markedly higher in those with larger intravesical prostatic protrusion, and that intravesical prostatic protrusion is correlated with the duration of postoperative urinary incontinence.
评估膀胱内前列腺突出作为腹腔镜根治性前列腺切除术后早期尿失禁恢复预测指标的意义。
本研究共纳入242例行腹腔镜根治性前列腺切除术的患者。收集尿失禁状态及尿失禁每日所需尿垫数量的数据。尿失禁定义为无需使用尿垫或偶尔使用安全尿垫。通过术前磁共振成像矢状面测量突出前列腺尖端至膀胱底部的垂直距离来评估膀胱内前列腺突出情况。根据膀胱内前列腺突出程度将患者分为两组，评估术后1、3、6和12个月时的尿失禁情况。研究术前因素与腹腔镜根治性前列腺切除术后尿失禁之间的相关性。
术后1、3、6和12个月时的尿失禁率分别为19%、50%、79.8%和92.1%。在多因素逻辑回归分析中，膀胱内前列腺突出是术后1、3、6、9和12个月早期尿失禁的显著独立预测因素。与膀胱内前列腺突出明显组（膀胱内前列腺突出≥5 mm）相比，在所有时间段内，膀胱内前列腺突出不明显组（膀胱内前列腺突出<5 mm）的尿失禁情况均有明显改善（P < 0.05）。
这些研究结果表明，腹腔镜根治性前列腺切除术患者中，膀胱内前列腺突出较大者术后发生尿失禁的可能性明显更高，且膀胱内前列腺突出与术后尿失禁持续时间相关。
