Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Endourol. 2020 Jul;34(7):782-787. doi: 10.1089/end.2020.0114. Epub 2020 Jun 15.
Preoperative anxiety has been shown to correlate with certain urinary symptoms in patients with certain types of voiding dysfunction, particularly overactive bladder. The purpose of this study was to evaluate if patient-reported anxiety correlates with pathologic characteristics, voiding symptoms, and objective metrics of bladder emptying in male patients undergoing holmium laser enucleation of the prostate (HoLEP). We began collecting patient-reported anxiety scores (generalized anxiety disorder 7-item or GAD-7) in addition to patient-reported scores of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) starting in November 2018 for men with LUTS due to benign prostate hyperplasia (BPH). We retrospectively evaluated the relationship between preoperative GAD-7 score with preoperative age, body mass index (BMI), preoperative urine flow metrics, preoperative postvoid residual (PVR), and preoperative symptom scores for LUTS (American Urological Association, BPH impact index [BII], and Michigan incontinence symptom index [MISI]) and ED (sexual health inventory for men and male sexual health questionnaire for ejaculatory dysfunction [MSHQ-EjD]). We then compared preoperative GAD-7 score with enucleated prostate weight, postoperative GAD-7 scores, postoperative urine flow metrics, postoperative PVR, and postoperative symptom scores for LUTS and ED. We included 139 patients for analysis. The preoperative GAD-7 score positively correlated with preoperative BII scores ( = 0.202, = 0.019), MISI total ( = 0.260, = 0.002), and MISI bother ( = 0.345, < 0.001) scores. Preoperative GAD-7 negatively correlated with preoperative MSHQ-EjD ( = -0.191, = 0.031). Following HoLEP, all four of these correlations disappear. The GAD-7 score did not correlate with age, BMI, preoperative urine flow metrics, preoperative PVR, or other preoperative LUTS and ED symptom scores. In addition, preoperative GAD-7 score showed no correlation with enucleated prostate weight, postoperative urine flow metrics, postoperative PVR, and postoperative LUTS and ED symptom scores. Higher preoperative anxiety correlated with more severe preoperative urinary LUTS, particularly incontinence symptoms, in patients undergoing HoLEP. Following HoLEP, these symptoms improve regardless of patient anxiety level.
术前焦虑已被证明与某些类型的排尿功能障碍患者的某些尿症状相关，尤其是膀胱过度活动症。本研究的目的是评估在接受钬激光前列腺剜除术（HoLEP）的男性患者中，患者报告的焦虑是否与病理特征、排尿症状和膀胱排空的客观指标相关。
自 2018 年 11 月以来，我们开始为因良性前列腺增生（BPH）而出现下尿路症状（LUTS）的男性患者收集患者报告的焦虑评分（广泛性焦虑障碍 7 项或 GAD-7）以及 LUTS 和勃起功能障碍（ED）的患者报告评分。我们回顾性评估了术前 GAD-7 评分与术前年龄、体重指数（BMI）、术前尿流量指标、术前剩余尿量（PVR）和 LUTS 的术前症状评分（美国泌尿外科学会、BPH 影响指数[BII]和密歇根失禁症状指数[MISI]）和 ED（男性性功能健康问卷和男性性健康问卷射精功能障碍[MSHQ-EjD]）之间的关系。然后，我们将术前 GAD-7 评分与剜除前列腺的重量、术后 GAD-7 评分、术后尿流量指标、术后 PVR 和 LUTS 和 ED 的术后症状评分进行了比较。
我们共纳入 139 例患者进行分析。术前 GAD-7 评分与术前 BII 评分（r=0.202，p=0.019）、MISI 总分（r=0.260，p=0.002）和 MISI 困扰评分（r=0.345，p<0.001）呈正相关。术前 GAD-7 与术前 MSHQ-EjD 呈负相关（r=-0.191，p=0.031）。HoLEP 后，这四种相关性均消失。GAD-7 评分与年龄、BMI、术前尿流量指标、术前 PVR 或其他术前 LUTS 和 ED 症状评分均无相关性。此外，术前 GAD-7 评分与剜除前列腺的重量、术后尿流量指标、术后 PVR 以及术后 LUTS 和 ED 症状评分均无相关性。
术前焦虑程度较高与接受 HoLEP 的患者术前更严重的尿 LUTS 相关，尤其是尿失禁症状。HoLEP 后，无论患者焦虑程度如何，这些症状均有所改善。
