Leapman Michael S, Stone Nelson N, Mock Stephen, Stock Richard G, Hall Simon J
Department of Urology, University of California, San Francisco, San Francisco, CA.
Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
Urology. 2016 Sep;95:151-7. doi: 10.1016/j.urology.2016.05.021. Epub 2016 May 19.
To define the incidence, time course, and risk factors associated with the development of urinary incontinence (UI) following prostate brachytherapy.
A total of 2461 men were identified who underwent permanent interstitial prostate brachytherapy with or without external beam radiation therapy. We examined the relationship between clinical- and treatment-related variables with the onset of UI, defined as leakage requiring pad usage, and further classified as stress (SUI) or urge (UUI) predominant, using univariate and Cox proportional hazards regression models. The changes in International Prostate Symptom Score and quality of life domains were assessed from baseline to last follow, and examined by UI status.
Patients were followed for a median of 6.4 years (interquartile range 4.1-9.3). UI was reported in 108 individuals (4.4%), at a median of 1.8 years (interquartile range 5 months-4.4 years): 30 with SUI and 78 with UUI. Seventy-two men (66.7%) reported using 1, 24 (22.2%) using 2, and 12 (11%) using ≥3 pads per day. On multivariate analysis, post-implantation transurethral resection of the prostate, urinary retention, external beam radiation therapy, and higher pretreatment International Prostate Symptom Score were significantly associated with the development of SUI, although transurethral resection of the prostate was the only significant risk factor associated with SUI. Men experiencing UI reported greater declines in urinary quality of life; however, no significant difference was observed between SUI and UUI.
UI occurred in 4.4% of patients following prostate brachytherapy and is more commonly urge-predominant in character. Distinct risk factors exist for the development of UUI vs SUI. Urinary leakage requiring pad usage was associated with declines in urinary QOL.
明确前列腺近距离放射治疗后尿失禁（UI）的发生率、时间进程及相关危险因素。
共纳入2461例接受永久性间质内前列腺近距离放射治疗（无论是否联合外照射放疗）的男性患者。我们采用单因素和Cox比例风险回归模型，研究临床及治疗相关变量与UI发生之间的关系，UI定义为需要使用尿垫的漏尿，并进一步分为以压力性尿失禁（SUI）为主或急迫性尿失禁（UUI）为主。从基线到末次随访评估国际前列腺症状评分及生活质量领域的变化，并按UI状态进行分析。
患者中位随访时间为6.4年（四分位间距4.1 - 9.3年）。108例（4.4%）患者报告发生UI，中位时间为1.8年（四分位间距5个月 - 4.4年）：30例为SUI，78例为UUI。72例男性（66.7%）报告每天使用1片尿垫，24例（22.2%）使用2片，12例（11%）每天使用≥3片尿垫。多因素分析显示，植入后经尿道前列腺切除术、尿潴留、外照射放疗以及较高的治疗前国际前列腺症状评分与SUI的发生显著相关，尽管经尿道前列腺切除术是与SUI相关的唯一显著危险因素。发生UI男性的尿生活质量下降更为明显；然而，SUI和UUI之间未观察到显著差异。
前列腺近距离放射治疗后4.4%的患者发生UI，且以急迫性为主更为常见。UUI和SUI的发生存在不同的危险因素。需要使用尿垫的尿失禁与尿生活质量下降相关。
