The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL, USA.
J Sex Med. 2017 Oct;14(10):1241-1247. doi: 10.1016/j.jsxm.2017.08.002. Epub 2017 Sep 2.
Urinary incontinence (UI) and erectile dysfunction (ED) remain the most common long-term complications of prostatectomy, with a significant impact on sexual health and quality of life.
To determine the relation between UI and moderate to severe ED and the risk factors for UI in patients undergoing robotic-assisted laparoscopic prostatectomy.
Patients in our institutional database who underwent robotic-assisted laparoscopic prostatectomy for prostate cancer (2006-2013) and who completed the University of California-Los Angeles Prostate Cancer Index and the Sexual Health Inventory for Men (SHIM) surveys at 12 months after prostatectomy were eligible for inclusion. Men who reported use of no urinary pads per day were considered continent, whereas men who used at least one pad per day were considered incontinent. Men with moderate to severe ED based on a SHIM score no higher than 11 were considered to have ED. Patients who had preoperative moderate to severe ED and/or UI based on these definitions were excluded from further analysis.
A better understanding of what increases the risk for UI after a prostatectomy and how it can co-occur with ED.
We analyzed 464 patients who met the inclusion criteria. After prostatectomy, 36% of patients had UI and 47% of patients had moderate to severe ED. Of all patients with ED, 45% (98 of 216) were incontinent compared with 27% (67 of 248) of patients without ED (P < .001). On multivariable analysis, older age at diagnosis (odds ratio [OR] = 1.05, P = .002) and ED (OR = 1.88, P = .005) were independent predictors for incontinence. The use of unilateral nerve sparing (OR = 1.03, P = .94) or no nerve sparing (OR = 0.53, P = .50) during surgery did not have an impact on postoperative incontinence.
Understanding that ED is an independent predictor of UI after robotic-assisted laparoscopic prostatectomy has important clinical implications and suggests a common anatomic pathway.
Our focus on different measurements of incontinence and their relation to ED and our use of validated questionnaires to define incontinence and ED were important strengths of this study. Limitations of our study include its retrospective nature and the fact that our results were drawn from a single-center database of a tertiary referral hospital.
Our results show that the presence of moderate to severe ED after prostatectomy is an independent risk factor for incontinence, suggesting a possible common pathway for these two complications. Further studies to investigate the anatomic and clinical bases of this relation are warranted. Tsikis ST, Nottingham CU, Faris SF. The Relationship Between Incontinence and Erectile Dysfunction After Robotic Prostatectomy: Are They Mutually Exclusive? J Sex Med 2017;14:1241-1247.
尿失禁（UI）和勃起功能障碍（ED）仍然是前列腺切除术的最常见长期并发症，对性健康和生活质量有重大影响。
确定尿失禁（UI）与中重度 ED 之间的关系，并确定接受机器人辅助腹腔镜前列腺切除术患者发生 UI 的危险因素。
我们的机构数据库中符合以下条件的患者有资格入选：因前列腺癌接受机器人辅助腹腔镜前列腺切除术（2006-2013 年），并在前列腺切除术后 12 个月完成加利福尼亚大学洛杉矶前列腺癌指数和男性性健康问卷（SHIM）调查。报告每天使用不超过 1 片尿垫的男性被认为是尿控的，而每天使用至少 1 片尿垫的男性则被认为是尿失禁的。SHIM 评分不高于 11 分的男性被认为患有 ED。基于这些定义，术前患有中重度 ED 和/或 UI 的患者被排除在进一步分析之外。
更好地了解前列腺切除术后哪些因素会增加 UI 的风险，以及它如何与 ED 同时发生。
我们分析了 464 名符合纳入标准的患者。前列腺切除术后，36%的患者出现 UI，47%的患者出现中重度 ED。所有 ED 患者中，45%（98/216）为尿失禁，而无 ED 患者为 27%（67/248）（P<.001）。多变量分析显示，诊断时年龄较大（优势比[OR] = 1.05，P =.002）和 ED（OR = 1.88，P =.005）是尿失禁的独立预测因素。单侧神经保留（OR = 1.03，P =.94）或无神经保留（OR = 0.53，P =.50）在手术过程中使用并不会对术后尿失禁产生影响。
了解 ED 是机器人辅助腹腔镜前列腺切除术后 UI 的独立预测因素，具有重要的临床意义，并提示存在共同的解剖途径。
我们对不同的尿失禁测量及其与 ED 的关系的关注，以及我们使用经过验证的问卷来定义尿失禁和 ED，这些都是本研究的重要优势。本研究的局限性包括其回顾性性质以及我们的结果来自于三级转诊医院的单中心数据库。
我们的结果表明，前列腺切除术后出现中重度 ED 是尿失禁的独立危险因素，这表明这两种并发症之间可能存在共同的途径。有必要进一步研究以探讨这种关系的解剖学和临床基础。Tsikis ST、Nottingham CU、Faris SF。机器人前列腺手术后尿失禁与勃起功能障碍的关系：它们是否相互排斥？J 性医学 2017；14：1241-1247。
