机器人辅助根治性前列腺切除术后逼尿肌活动不足的发生率及预测因素：一项前瞻性观察研究。

Prevalence and predictors of postoperative detrusor underactivity after robot-assisted radical prostatectomy: A prospective observational study.

机构信息

Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.

Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

出版信息

Int J Urol. 2021 Jul;28(7):734-740. doi: 10.1111/iju.14549. Epub 2021 Mar 20.

DOI:10.1111/iju.14549

PMID:33745187

Abstract

OBJECTIVES

To identify the prevalence and predictors of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy.

METHODS

We carried out a prospective observational study of 64 patients scheduled for robot-assisted radical prostatectomy using urodynamic study before and 1 month after robot-assisted radical prostatectomy. Detrusor underactivity was defined as maximum flow rate ≤15 mL/s and detrusor pressure at maximum flow rate ≤25 cmH O during voiding. Incidences of pre- and postoperative detrusor underactivity were assessed, and predictors of postoperative detrusor underactivity were determined using uni- and multivariate logistic regression analyses. Factors comprised patient characteristics (age, prostate weight etc.), operative factors (surgical duration, nerve sparing etc.) and preoperative urodynamic study parameters (maximum flow rate, bladder contractile index etc.).

RESULTS

Pre- and postoperative detrusor underactivity at 1 month after robot-assisted radical prostatectomy were detected in one patient (1.6%) and 24 patients (37.5%), respectively. Univariate analysis selected preoperative maximum flow rate (P = 0.02), detrusor pressure at maximum flow rate (P = 0.04) and bladder contractile index (P < 0.01) as predictors of postoperative detrusor underactivity (odds ratio 0.83, 0.97 and 0.94, respectively). On multivariate analyses, only preoperative bladder contractile index was associated with postoperative detrusor underactivity (P < 0.01; odds ratio 0.94). A cut-off of 102.8 offered optimal accuracy in receiver operating characteristic analysis. Patient characteristics and operative factors were not significantly associated with postoperative detrusor underactivity.

CONCLUSIONS

A comparatively high prevalence of postoperative detrusor underactivity is observed in patients at 1 month after robot-assisted radical prostatectomy. Patients with preoperative low bladder contractile index have a higher probability of developing early postoperative detrusor underactivity after robot-assisted radical prostatectomy.

摘要

目的

确定机器人辅助前列腺根治术后早期尿动力学检查中逼尿肌活动低下的发生率和预测因素。

方法

我们对 64 例接受机器人辅助前列腺根治术的患者进行了前瞻性观察研究，在手术前和手术后 1 个月进行尿动力学检查。逼尿肌活动低下定义为排尿时最大尿流率≤15ml/s，最大尿流率时逼尿肌压≤25cmH2O。评估术前和术后逼尿肌活动低下的发生率，并使用单变量和多变量逻辑回归分析确定术后逼尿肌活动低下的预测因素。因素包括患者特征（年龄、前列腺重量等）、手术因素（手术时间、神经保留等）和术前尿动力学检查参数（最大尿流率、膀胱收缩指数等）。

结果

术后 1 个月发现 1 例（1.6%）和 24 例（37.5%）患者存在术前和术后逼尿肌活动低下。单变量分析选择术前最大尿流率（P=0.02）、最大尿流率时逼尿肌压（P=0.04）和膀胱收缩指数（P<0.01）作为术后逼尿肌活动低下的预测因素（比值比分别为 0.83、0.97 和 0.94）。多变量分析中，仅术前膀胱收缩指数与术后逼尿肌活动低下相关（P<0.01；比值比 0.94）。在接受者操作特征分析中，截断值为 102.8 时具有最佳准确性。患者特征和手术因素与术后逼尿肌活动低下无显著相关性。