Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Neurourol Urodyn. 2019 Jun;38(5):1353-1362. doi: 10.1002/nau.23986. Epub 2019 Apr 13.
To evaluate the patient-reported outcome measures (PROMs) and urodynamic findings in men seeking intervention for lower urinary tract symptoms (LUTS) after robotic-assisted radical prostatectomy (RARP) in a regional referral center for continence surgery.
Consecutive men with post-RARP LUTS, who were referred for specialist evaluation and urodynamics between December 2012 and October 2017, were evaluated. Men were invited to complete the International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form (ICIQ-MLUTS) pre-operatively and at 6, 12 and 18 months post-RARP.
In total 64/860 (7.4%) men post-RARP were referred for specialist evaluation. There was a significant increase in total ICIQ-MLUTS and bother scores at 6, 12 and 18 months compared with the baseline in these men (P < 0.001 and P < 0.05, respectively). Urodynamics identified 41/64 (64%) had urodynamic stress incontinence (USI) only, 2/64 (3%) had detrusor overactivity (DO) only and 11/64 (17%) had a combination of USI and DO. Of those referred to a continence specialist 29/64 (45%) underwent a continence procedure.
Patients with bothersome LUTS post-RARP have higher baseline ICIQ-MLUTs scores and significant worsening of total scores at all time points compared with the baseline. Routine use of PROMs may identify patients at risk of bothersome symptoms after RARP and prompt earlier referral for further management of their LUTS. Urodynamic evaluation revealed that the most common finding was pure stress incontinence but the range of urodynamic diagnoses highlights the need to perform urodynamics before making treatment decisions for men with LUTS post-RARP.
评估在区域性控尿手术转诊中心接受机器人辅助根治性前列腺切除术（RARP）后因下尿路症状（LUTS）寻求干预的男性的患者报告结局测量（PROM）和尿动力学发现。
连续评估了 2012 年 12 月至 2017 年 10 月期间因专科评估和尿动力学检查而转诊的 RARP 后出现 LUTS 的男性。男性在术前和 RARP 后 6、12 和 18 个月时被邀请完成国际尿控协会男性下尿路症状问卷长表（ICIQ-MLUTS）。
RARP 后共有 64/860（7.4%）名男性因专科评估而转诊。这些男性在 6、12 和 18 个月时的总 ICIQ-MLUTS 和困扰评分与基线相比均显著增加（P<0.001 和 P<0.05）。尿动力学检查发现 41/64（64%）仅有尿动力学压力性尿失禁（USI），2/64（3%）仅有逼尿肌过度活动（DO），11/64（17%）有 USI 和 DO 两种情况。在转诊给控尿专家的 64 名患者中，有 29/64（45%）接受了控尿手术。
与基线相比，RARP 后出现烦扰性 LUTS 的患者具有更高的基线 ICIQ-MLUTs 评分，并且在所有时间点上总评分都有显著恶化。常规使用 PROM 可能会识别出 RARP 后有烦扰症状风险的患者，并促使他们更早地转诊，以进一步管理他们的 LUTS。尿动力学检查结果显示，最常见的发现是单纯性压力性尿失禁，但尿动力学诊断的范围强调了在为 RARP 后出现 LUTS 的男性做出治疗决策之前，需要进行尿动力学检查。
