Morey Allen F, Singla Nirmish, Carmel Maude, Klein Alexandra, Tausch Timothy J, Siegel Jordan, Tachibana Isamu, Scott Jeremy
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Can J Urol. 2017 Feb;24(1):8664-8669.
We implemented a standardized Standing Cough Test (SCT) for assessment of men with post-prostatectomy incontinence (PPI) and stratified results according to an objective clinical grading scale in an attempt to facilitate male anti-incontinence surgical procedure selection.
SCT was routinely performed during the initial outpatient consultation for PPI. Incontinence severity was recorded based on a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI. Each patient was assigned an incontinence grade score of 0 through 4 during the SCT. Men with mild stress urinary incontinence (SUI) (grades 0-2) were offered sling surgery while those with heavier SUI (grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to preoperative patient-reported pads per day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.
Among 62 consecutive PPI patients, 20 (32%) were graded as mild based on SCT, while the majority (42/62, 68%) were graded as moderate-severe. Average time from prostatectomy to treatment was 6 years. MSIGS grade demonstrated a strong correlation with preoperative PPD (r = 0.74). Among the 53 patients who underwent surgery for PPI, 14 with mild SUI received a sling, while 39 (74%) more severe cases received an AUS. Patient-reported improvement was high overall in both groups (median 95%).
Most men with chronic PPI present for definitive treatment in a delayed manner after prostatectomy despite having severe incontinence. The SCT provides immediate, objective information about the severity of PPI which strongly correlates with patient-reported pads-per-day and may expedite anti-incontinence surgical procedure selection.
我们实施了一项标准化的站立咳嗽试验（SCT），用于评估前列腺切除术后尿失禁（PPI）的男性患者，并根据客观临床分级量表对结果进行分层，以促进男性抗尿失禁手术的选择。
在PPI患者首次门诊咨询期间常规进行SCT。根据一种新的男性压力性尿失禁分级量表（MSIGS）记录尿失禁严重程度，以对PPI进行分层。在SCT期间，为每位患者分配一个0至4分的尿失禁分级分数。轻度压力性尿失禁（SUI）（0 - 2级）的男性患者接受吊带手术，而重度SUI（3 - 4级）的患者接受人工尿道括约肌（AUS）植入术。将MSIGS分级与术前患者报告的每日使用尿垫数（PPD）相关联，并评估抗尿失禁手术的患者报告结局。
在连续62例PPI患者中，20例（32%）根据SCT分级为轻度，而大多数（42/62，68%）分级为中度至重度。从前列腺切除到治疗的平均时间为6年。MSIGS分级与术前PPD显示出强烈的相关性（r = 0.74）。在53例接受PPI手术的患者中，14例轻度SUI患者接受了吊带手术，而39例（74%）病情较重的患者接受了AUS植入术。两组患者报告的总体改善情况都很高（中位数为95%）。
大多数慢性PPI男性患者在前列腺切除术后尽管存在严重尿失禁，但仍延迟寻求确定性治疗。SCT提供了关于PPI严重程度的即时、客观信息，这与患者报告的每日尿垫使用数密切相关，并可能加快抗尿失禁手术的选择。
