预测人工尿道括约肌植入术后的成功情况：哪些术前因素会影响患者术后满意度？
Predicting success after artificial urinary sphincter: which preoperative factors drive patient satisfaction postoperatively?
作者信息
Chertack Nathan, Gill Bradley C, Angermeier Kenneth W, Montague Drogo K, Wood Hadley M
机构信息
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
出版信息
Transl Androl Urol. 2017 Dec;6(6):1138-1143. doi: 10.21037/tau.2017.10.05.
BACKGROUND
To determine which preoperative factors drive patient-reported quality of life (QoL) after artificial urinary sphincter (AUS) implantation.
METHODS
Men receiving AUS after prostate cancer treatment were identified from a prospectively collected dataset. Preoperative factors were recorded during the initial incontinence consultation. Patients underwent urodynamic testing (UDS) preoperatively at surgeon discretion. Patients were surveyed by telephone postoperatively and given the EPIC Urinary Domain (EPIC-UD) and Urinary Distress Inventory (UDI-6) questionnaires. Differences in postoperative maximum pads per day (MxPPD) and questionnaire scores were compared across preoperative factors, with P¡Ü0.05 indicating statistical significance.
RESULTS
Telephone survey was completed by 101 of 238 patients (42%). Median age was 69 [63-75] years, BMI was 29 [26-32] kg/m. MxPPD was 5 [3-9] preoperatively and 2 [1-3] postoperatively (r=0.255, P=0.011). Postoperative median EPIC-UD was 82 [67-89] and UDI-6 was 22 [11-36]. Postoperative MxPPD was lower in patients who reported being able to store urine before AUS {2 [1-2] . 2 [1-4], P=0.046}, and lower with urodynamically-proven detrusor overactivity (DO) {1.5 [1-2] with . 2 [1-4] without, P=0.050}. Detrusor pressure at maximum flow was negatively associated with QoL as measured by EPIC-UD score (r=-0.346, P=0.013) and UDI-6 score (r=0.413, P=0.003). Although 41 (41%) patients had a history of radiation, postoperative outcomes did not significantly differ with or without a history of radiation.
CONCLUSIONS
Few preoperative factors predict QoL after AUS insertion.
背景
确定哪些术前因素会影响人工尿道括约肌（AUS）植入术后患者报告的生活质量（QoL）。
方法
从一个前瞻性收集的数据集中识别出接受前列腺癌治疗后植入AUS的男性患者。术前因素在初次尿失禁咨询时记录。患者根据外科医生的判断在术前接受尿动力学检查（UDS）。术后通过电话对患者进行调查，并给予患者EPIC泌尿领域（EPIC-UD）问卷和泌尿困扰量表（UDI-6）问卷。比较术前因素之间术后每日最大尿垫使用量（MxPPD）和问卷得分的差异，P≤0.05表示具有统计学意义。
结果
238例患者中有101例（42%）完成了电话调查。中位年龄为69[63-75]岁，体重指数为29[26-32]kg/m²。术前MxPPD为5[3-9]，术后为2[1-3]（r=0.255，P=0.011）。术后EPIC-UD中位数为82[67-89]，UDI-6为22[11-36]。报告在植入AUS前能够储存尿液的患者术后MxPPD较低{2[1-2]对2[1-4]，P=0.046}，尿动力学证实存在逼尿肌过度活动（DO）的患者术后MxPPD也较低{有DO的患者为1.5[1-2]，无DO的患者为2[1-4]，P=0.050}。最大尿流率时的逼尿肌压力与EPIC-UD评分（r=-0.346，P=0.013）和UDI-6评分（r=-0.413，P=0.003）所衡量的生活质量呈负相关。尽管41例（41%）患者有放疗史，但有无放疗史的术后结果无显著差异。
结论
很少有术前因素能够预测AUS植入后的生活质量。
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