Flinders Medical Centre, Adelaide, South Australia, Australia.
South Australia Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, South Australia, Australia.
BMC Urol. 2020 Jan 31;20(1):8. doi: 10.1186/s12894-020-0578-x.
Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP).
We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score.
The observed median MUL in this study was 14.6 mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p = 0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p = 0.006). MUL was also associated with change in continence after surgery (β = 1.22, p = 0.002).
MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.
术后尿失禁是选择接受根治性前列腺切除术（RP）治疗前列腺癌的患者的一个重要关注点。我们的研究目的是确定术前 MUL 对接受机器人辅助腹腔镜前列腺切除术（RALP）的男性 12 个月时控尿结局的影响。
我们使用南澳大利亚前列腺癌临床结果协作组（SA-PCCOC）数据库，确定了 602 名由高容量外科医生进行 RALP 的患者。仅纳入接受了专科盆底物理治疗师评估和教育、在治疗前完成了 EPIC 问卷且术后 12 个月内未接受放疗的患者。MUL 测量值取自术前磁共振成像（MRI）扫描。使用扩展前列腺癌指数综合量表（EPIC-26）的短版来测量控尿结果。控尿定义为 EPIC-26 尿控域评分中的 100/100。
本研究中观察到的中位数 MUL 为 14.6mm。MUL 与基线控尿之间无关联。MUL 与 RALP 后 12 个月的控尿相关（OR 1.13，95%CI 1.03-1.21，p=0.0098）。在手术前控尿的男性中，MUL 与 RALP 后 12 个月恢复控尿相关（OR 1.15，1.05-1.28，p=0.006）。MUL 还与术后控尿变化相关（β=1.22，p=0.002）。
MUL 对基线控尿无影响，但对 RALP 后 12 个月的控尿结局有积极且显著的关联。
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