膀胱尿道狭窄和膀胱颈狭窄内镜治疗后复发率及尿失禁的差异
Differences in Recurrence Rate and Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis.
作者信息
Kranz Jennifer, Reiss Philipp C, Salomon Georg, Steffens Joachim, Fisch Margit, Rosenbaum Clemens M
机构信息
Department for Urology and Pediatric Urology, St. Antonius Hospital, Eschweiler, Germany.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Front Surg. 2017 Aug 10;4:44. doi: 10.3389/fsurg.2017.00044. eCollection 2017.
OBJECTIVES
The objective of this study was to compare the recurrence rate and incontinence after endoscopic treatment of vesicourethral stenosis (VUS) after radical prostatectomy (RP) and for bladder neck stenosis (BNS) after transurethral resection of the prostate (TURP).
METHODS
Retrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and incontinence. Chi-squared tests and -tests were used to model the differences between groups.
RESULTS
A total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44-86), mean follow-up 27.1 months (1-98). Mean time to recurrence after initial therapy was 23.9 months (1-156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1-159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; = 0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; = 0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful ( = 0.031). The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; = 0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; = 0.091), whereas the rate of incontinence (13.8 for VUS vs. 0% for BNS; = 0.005) stayed significantly higher in patients treated for VUS.
CONCLUSION
Most patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to incontinence. Patients must be counseled regarding the increased risk of incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.
目的
本研究的目的是比较根治性前列腺切除术后膀胱尿道狭窄（VUS）和经尿道前列腺电切术后膀胱颈狭窄（BNS）内镜治疗后的复发率和尿失禁情况。
方法
对2009年3月至2016年6月期间在德国三个三级医疗中心接受VUS内镜治疗或TURP术后BNS内镜治疗的患者进行回顾性分析。研究终点为复发率和尿失禁。采用卡方检验和t检验对组间差异进行建模。
结果
共有147例患者接受了VUS（59.2%）或BNS（40.8%）的内镜治疗。平均年龄为68.3岁（范围44 - 86岁），平均随访27.1个月（1 - 98个月）。初始治疗后至复发的平均时间为23.9个月（1 - 156个月），VUS或BNS先前内镜治疗后至复发的平均时间为12.0个月（1 - 159个月）。接受VUS治疗的患者在内镜治疗前接受放疗的频率显著更高（33.3%对13.3%；P = 0.006），且复发率显著更高（59.8%对41.7%；P = 0.031）。VUS的经尿道切除术总体成功率为40.2%，BNS的经尿道切除术成功率为58.3%。BNS的经尿道切除术显著更成功（P = 0.031）。成功病例中BNS与VUS的经尿道切除术平均次数分别为1.5次和1.8次，差异无统计学意义。VUS治疗患者的尿失禁发生率显著更高（13.8%对1.7%；P = 0.011）。排除内镜治疗前接受放疗的患者后，两组间复发率无显著差异（VUS为60.3%，BNS为44.2%；P = 0.091），而VUS治疗患者的尿失禁发生率（VUS为13.8%，BNS为0%；P = 0.005）仍显著更高。
结论
大多数BNS患者通过内镜治疗成功。VUS患者的成功率较低。两种狭窄在尿失禁方面存在差异。必须告知患者VUS内镜治疗后尿失禁风险增加，与先前放疗无关。需要更长时间的随访以了解长期结果。
Zotero 插件