Aning Jonathan J, MacKenzie Kenneth R, Fabricius Michael, McColl Elaine, Johnson Mark I, Tandogdu Zafer, Soomro Naeem A, Harding Christopher
Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Urol Oncol. 2018 Aug;36(8):364.e15-364.e22. doi: 10.1016/j.urolonc.2018.05.017. Epub 2018 Jun 9.
To prospectively evaluate short- to medium-term patient-reported lower urinary tract symptoms (LUTS) and their effect on health-related quality of life (HRQoL) using validated questionnaires in a large cohort of patients following robotic-assisted radical prostatectomy (RARP) for prostate cancer.
HRQoL and LUTS outcomes were prospectively assessed in 357 consecutive men undergoing RARP at a single center from 2012 to 2015 using the functional assessment of cancer therapy-prostate (FACT-P) and the international consultation on incontinence modular questionnaire-male LUTS (ICIQ-MLUTS). Questionnaires were administered at baseline, 6, 12, and 18 months. Data were analyzed using paired t-tests and ANOVA.
Questionnaire completion rates were high (over 60% of eligible men completed 18-month follow-up). Mean Total FACT-P did not significantly change after RARP: 125.95 (standard deviation [SD] = 19.82) at baseline and 125.86 (SD = 21.14) at 18-months (P = 0.55). Mean total ICIQ-MLUTS also remained unchanged: 18.69 (SD = 10.70) at baseline and 18.76 (SD = 11.33) at 18-months (P = 0.11). Mean voiding score significantly reduced from 10.34 (SD = 5.78) at baseline to 6.33 (SD = 3.99) at 6 months after RARP (P<0.001). A reciprocal significant increase in storage score was observed: 5.34 (SD = 4.26) at baseline, 9.65 (SD = 5.71) at 6 months (P<0.001). Subanalyses of ICIQ-MLUTS scores revealed increases in storage symptoms were exclusively within urinary incontinence domains and included significant increases in both urge and stress urinary incontinence scores.
Overall, patient-reported outcome measures evaluating HRQoL and LUTS do not significantly change after RARP. Detailed analysis reveals significant changes within LUTS domains do occur after surgery which could be overlooked if only total LUTS scores are reported.
使用经过验证的问卷，对一大群接受机器人辅助根治性前列腺切除术（RARP）治疗前列腺癌的患者进行前瞻性评估，以了解患者报告的短期至中期下尿路症状（LUTS）及其对健康相关生活质量（HRQoL）的影响。
2012年至2015年期间，在单一中心对357例连续接受RARP的男性患者进行前瞻性评估，使用癌症治疗功能评估-前列腺（FACT-P）和尿失禁国际咨询模块化问卷-男性LUTS（ICIQ-MLUTS）评估HRQoL和LUTS结果。在基线、6个月、12个月和18个月时发放问卷。使用配对t检验和方差分析对数据进行分析。
问卷完成率很高（超过60%的符合条件男性完成了18个月的随访）。RARP后FACT-P总分无显著变化：基线时为125.95（标准差[SD]=19.82），18个月时为125.86（SD=21.14）（P=0.55）。ICIQ-MLUTS总分也保持不变：基线时为18.69（SD=10.70），18个月时为18.76（SD=11.33）（P=0.11）。排尿平均评分从基线时的10.34（SD=5.78）显著降低至RARP后6个月时的6.33（SD=3.99）（P<0.001）。观察到储尿评分有相应的显著增加：基线时为5.34（SD=4.26），6个月时为9.65（SD=5.71）（P<0.001）。ICIQ-MLUTS评分的亚组分析显示，储尿症状的增加仅在尿失禁领域，包括急迫性和压力性尿失禁评分均显著增加。
总体而言，评估HRQoL和LUTS的患者报告结局指标在RARP后无显著变化。详细分析显示，手术后LUTS领域确实发生了显著变化，如果仅报告LUTS总分，这些变化可能会被忽视。
