Morey Allen, Singla Nirmish, Chung Paul, Klein Alexandra, Tausch Timothy, Siegel Jordan, Tachibana Isamu, Scott Jeremy, Carmel Maude
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Video J Prosthet Urol. 2016 Feb 24;2.
We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male anti-incontinence procedure selection.
Between September 2014 and July 2015, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0-2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.
Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r=0.74). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVance® male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p=0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1-20).
The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.
我们制定了一种客观的临床分级量表来描述前列腺切除术后尿失禁（PPI）的情况，并评估其作为一种有助于男性抗尿失禁手术选择工具的用途。
在2014年9月至2015年7月期间，我们前瞻性地实施了一种新型男性压力性尿失禁分级量表（MSIGS），以根据尿失禁严重程度对PPI患者进行分层。纳入的患者为那些因PPI前来就诊且之前未接受过抗尿失禁手术的患者。在初次门诊咨询期间，根据两名进行站立咳嗽试验（SCT）的检查者的共识，前瞻性地为每位患者分配一个0至4分的尿失禁分级评分。所有患者在SCT前至少60分钟不排尿。轻度压力性尿失禁（MSIGS 0 - 2级）的男性患者接受AdVance吊带手术，而重度压力性尿失禁（MSIGS 3 - 4级）的男性患者接受人工尿道括约肌（AUS）植入手术。MSIGS分级与患者报告的每日使用尿垫数（PPD）相关，并评估了抗尿失禁手术的患者报告结局。
在连续62例新的PPI患者中，根据SCT，20例被评为轻度[5例（8%）为0级，10例（16%）为1级，5例（8%）为2级]，而42例被评为中重度[10例（16%）为3级，32例（52%）为4级]。MSIGS分级与术前PPD显示出强烈相关性（r = 0.74）。在53例因PPI接受手术干预的患者中，14例轻度压力性尿失禁患者接受了AdVance®男性尿道吊带治疗（MSIGS 0、1或2级），而39例更严重的病例接受了AUS治疗（MSIGS 3或4级）。患者报告的总体改善率较高（中位数为95%），吊带和AUS患者的改善率相似（分别为95%和96.5%，p = 0.596）。从根治性前列腺切除术到抗尿失禁手术的中位时间为5.4年（范围1 - 20年）。
男性压力性尿失禁分级量表提供了一种快速、简单、非侵入性的PPI严重程度客观评估方法，它与患者报告的每日使用尿垫数密切相关，并且似乎有助于抗尿失禁手术的选择。
