Reva I A, Zhivov A V, Okishev A V, Dyakov V V, Bernikov A N, Bormotin A V, Pushkar D Yu
Department of Urology, A.I. Evdokimov MSUMD, Moscow.
Urologiia. 2016 Nov(5):70-78.
To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators.
This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified.
During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life.
The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.
评估膀胱尿道吻合口狭窄（VAS）内镜矫正前后伴发压力性尿失禁（SUI）的发生率和分级、生活质量，以及内镜干预次数对这些指标的影响。
这是一项对2010年至2015年在我院接受根治性前列腺切除术（RP）并随后出现VAS的患者的病历进行的回顾性研究以及电话调查。该调查包括使用生活质量问卷在VAS内镜矫正前后SUI严重程度和生活质量的数据；确定主要影响生活质量的因素（SUI或梗阻性症状）。
在上述期间，共进行了1453例RP手术。有60例VAS病例，其中56例（93%）纳入研究。RP术后压力性尿失禁发生在64.3%的患者中，平均生活质量评分为3.95（标准差=0.64；变异系数=16.2%）。在VAS内镜矫正前，87.5%的患者报告梗阻性症状是不满的主要原因。VAS内镜矫正后，82.1%的患者出现SUI。15例患者出现新发尿失禁，29例（51.8%）患者SUI分级更高。观察到的SUI分级变化无统计学意义（配对t检验1.98，p>0.05）。内镜矫正后的平均生活质量评分为2.54（标准差=0.73；变异系数=28.6%，配对t检验5.08，p<0.05）。VAS内镜矫正后，78.6%的患者报告SUI是生活质量下降的最重要因素。
该研究揭示了VAS合并SIU的高发生率。VAS内镜矫正后患者的生活质量有显著改善，这是由于排尿功能障碍模式的改变对生活质量产生了重大负面影响。VAS内镜矫正次数与SUI分级及患者生活质量之间无统计学显著相关性。
