Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
World J Urol. 2018 Jan;36(1):21-26. doi: 10.1007/s00345-017-2112-7. Epub 2017 Oct 30.
Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors.
From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90 days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function.
A total of 411 men who completed the baseline survey and at 90 days postoperatively were included. On multivariate linear regression, younger age (p < 0.01), higher preoperative sexual function (< 0.01), single marital status (p = 0.04) and more post-surgery email contacts (p = 0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p = 0.01), higher baseline continence (p < 0.01) and more post-surgery physical therapy visits (p < 0.01) were associated with higher declines.
Patients with the poorest quality of life outcomes at 90 days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.
机器人根治性前列腺切除术专注于肿瘤治愈、尿控和性功能恢复。然而，对于尿控和性功能下降对医疗保健利用的影响知之甚少。我们旨在确定这些因素。
从 2011 年 3 月至 2013 年 9 月，在我们的医疗保健系统内接受机器人前列腺切除术的所有男性均被纳入研究。男性在诊断时和术后 90 天完成扩展前列腺癌指数复合 26 调查。根据性功能和尿失禁领域评分的变化对患者进行分层。检查患者、治疗和术后利用模式与性功能和尿控下降程度的关系。多元线性回归用于确定与尿控和性功能下降独立相关的因素。
共有 411 名完成基线调查和术后 90 天调查的男性被纳入研究。多元线性回归分析显示，年龄较小（p<0.01）、术前性功能较高（<0.01）、单身婚姻状况（p=0.04）和术后电子邮件联系较多（p=0.04）与性功能下降幅度较大相关。对于尿控，无前列腺癌家族史（p=0.01）、基线尿控较好（p<0.01）和术后物理治疗就诊次数较多（p<0.01）与尿控下降幅度较大相关。
术后 90 天生活质量最差的患者更有可能通过电子邮件和与性功能和尿失禁相关的物理治疗就诊来寻求医疗保健。这表明最大限度地提高治疗后生活质量可能会降低医疗保健利用。
