Levy Alison, Fleishman Aaron, Jackson Max, Waisman Adrian, Chan Marianne, Kleeman Allison, Crociani Catrina, McAnally Kyle, Leader Jenna, Warnhoff Marysa, Jiang David, Wagner Andrew, Chang Peter
Lahey Hospital and Medical Center, Burlington, MA.
Beth Israel Deaconess Medical Center, Boston, MA.
Urology. 2021 Sep;155:160-164. doi: 10.1016/j.urology.2021.04.029. Epub 2021 May 7.
To evaluate whether pre-operative pelvic floor physical therapy (PFPT) parameters may predict early return of urinary continence after RP. While long-term urinary continence is eventually achieved in most patients who undergo radical prostatectomy (RP), predicting when patients will become continent is challenging. Prior studies aiming to predict return of post-operative continence have not evaluated patient-specific pelvic floor strength parameters.
We reviewed a prospectively maintained database of patients undergoing RP who underwent pre-operative PFPT consultation and completed 3-month patient-reported quality of life evaluation. Trained therapists documented pelvic strength parameters. Urinary continence was defined as using 0 or 1 pad per day. We evaluated the association of PFPT parameters with urinary continence at 3 months, adjusting for other factors that could affect continence.
144 men met inclusion criteria. The majority of patients underwent nerve-sparing procedures and had intermediate- or high-risk prostate cancer. At 3 months, 90 of 144 (62.5%) were continent, while 54 of 144 (37.5%) were not. On multivariable analysis, prostate volume (OR 0.98, 95% CI 0.96-1.00) and pelvic floor endurance (OR 2.71, 95% CI 1.23-6.17) were significantly associated with being continent at 3 months. 56 of 76 (74%) men with good pelvic floor endurance were continent at 3 months, while only 34 of 68 (50%) men with poor endurance were continent (P = .006).
Pre-operative assessment of pelvic floor endurance is an objective measure that may allow more accurate prediction of early continence after radical prostatectomy. Improved patient counseling could positively impact patient satisfaction and quality of life and reduce decision regret.
评估术前盆底物理治疗（PFPT）参数是否可预测根治性前列腺切除术（RP）后尿失禁的早期恢复情况。虽然大多数接受根治性前列腺切除术（RP）的患者最终能实现长期尿失禁，但预测患者何时恢复控尿具有挑战性。此前旨在预测术后尿失禁恢复情况的研究尚未评估患者特异性的盆底力量参数。
我们回顾了一个前瞻性维护的数据库，该数据库包含接受RP且术前接受PFPT咨询并完成3个月患者报告的生活质量评估的患者。训练有素的治疗师记录盆底力量参数。尿失禁定义为每天使用0或1片尿垫。我们评估了PFPT参数与3个月时尿失禁的相关性，并对其他可能影响尿失禁的因素进行了校正。
144名男性符合纳入标准。大多数患者接受了保留神经的手术，患有中危或高危前列腺癌。3个月时，144名患者中有90名（62.5%）实现控尿，而144名中有54名（37.5%）未实现控尿。多变量分析显示，前列腺体积（比值比[OR]0.98，95%置信区间[CI]0.96 - 1.00）和盆底耐力（OR 2.71，95%CI 1.23 - 6.17）与3个月时实现控尿显著相关。76名盆底耐力良好的男性中有56名（74%）在3个月时实现控尿，而68名耐力较差的男性中只有34名（50%）实现控尿（P = 0.006）。
术前评估盆底耐力是一种客观指标，可能有助于更准确地预测根治性前列腺切除术后的早期控尿情况。改善患者咨询可能会对患者满意度和生活质量产生积极影响，并减少决策遗憾。
