University of Oslo, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
J Urol. 2014 Oct;192(4):1155-61. doi: 10.1016/j.juro.2014.03.113. Epub 2014 Apr 12.
We examined prevalence rates, and changes in continence and incontinence before and after radical prostatectomy for prostate cancer by comparing different definitions. We also studied the descriptive validity of the grading system of Ellison et al for post-prostatectomy incontinence and baseline predictors of post-prostatectomy incontinence at 12 months.
This national prospective study included 844 patients treated with radical prostatectomy between 2005 and 2009. Adverse effects, including urinary dysfunction and bother, were reported by 735 patients (88%) using the EPIC-50 and UCLA-PCI validated questionnaires at baseline and 12-month followup. Linear regression analysis was done to examine baseline predictors and the degree of post-prostatectomy incontinence at followup.
At 12 months after radical prostatectomy 74% of patients reported post-prostatectomy incontinence, of whom 40% used pads daily, 34% reported occasional dribbling without pads and 26% had total urinary control. When defined as total incontinence/no urinary control, severe post-prostatectomy incontinence was reported by 3% of the men but 25% had severe post-prostatectomy incontinence according to the stratification of Ellison et al. Of patients with preoperative incontinence 14% improved postoperatively. Predictors of post-prostatectomy incontinence were age 65 years or greater, not working, sexual dysfunction and incontinence preoperatively. The latter 2 remained the strongest predictors on multivariate analysis. Prostate cancer related variables were not associated with post-prostatectomy incontinence.
The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.
通过比较不同定义，我们检查了前列腺癌根治术后的尿失禁和控尿率的流行率及变化。我们还研究了 Ellison 等人对前列腺切除术后尿失禁分级系统的描述有效性以及术后 12 个月时前列腺切除术后尿失禁的基线预测因素。
这项全国性前瞻性研究纳入了 2005 年至 2009 年间接受根治性前列腺切除术治疗的 844 例患者。735 例患者（88%）使用 EPIC-50 和 UCLA-PCI 验证问卷在基线和 12 个月随访时报告了不良反应，包括尿功能障碍和困扰。线性回归分析用于检查基线预测因素和随访时的前列腺切除术后尿失禁程度。
在根治性前列腺切除术后 12 个月时，74%的患者报告有前列腺切除术后尿失禁，其中 40%每天使用尿垫，34%报告偶尔无尿垫漏尿，26%有完全尿控。当定义为完全失禁/无尿控时，3%的男性报告有严重的前列腺切除术后尿失禁，但根据 Ellison 等人的分层，25%的男性有严重的前列腺切除术后尿失禁。术前有尿失禁的患者中有 14%在术后得到改善。前列腺切除术后尿失禁的预测因素是年龄 65 岁或以上、不工作、性功能障碍和术前尿失禁。在多变量分析中，后两者仍然是最强的预测因素。前列腺癌相关变量与前列腺切除术后尿失禁无关。
根据应用的定义，前列腺切除术后尿失禁的流行率差异很大。在我们看来，尿失禁可以报告为任何渗漏，而不仅仅是使用尿垫并在症状量表上进行分级。术前性功能障碍和尿失禁是术后 12 个月随访时前列腺切除术后尿失禁的最强预测因素。
