Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands.
Neurourol Urodyn. 2021 Aug;40(6):1550-1558. doi: 10.1002/nau.24703. Epub 2021 May 18.
Individualized information about the risk of incontinence after prostatectomy could help patients in shared decision-making.
We compared a historical control cohort (n = 254; between June 2016 and 2017) that received standardized information about the risk of incontinence after robot-assisted radical prostatectomy (RARP) with a prospective patient cohort (n = 254; between June 2017 and May 2018) that received individualized information of the chance of recovery of incontinence within 6 months postoperatively based on the continence prediction tool (CPRED). We measured switch in treatment choice, health-related quality of life (QoL) in both cohorts and the accuracy of the CPRED tool.
Patients in the individualized information group with RARP as initial preference switched more often to another treatment than patients who received standardized information (16% vs. 5%; p = 0.001). Patients in the individualized information group with a high risk of incontinence and with RARP as initial preference switched more often to other treatments than patients in intermediate/low risk of incontinence (35% vs. 9.8%; p = 0.001). Patients with a low risk of incontinence choosing RARP after individualized information were less likely to use more than one diaper a day at any time postoperative (p = 0.001) compared to men with an intermediate/high incontinence risk. Overall QoL was worse in patients with incontinence than patients with continence 6 and 12 months after RARP (respectively; p < 0.0001 and p = 0.007).
Personalized information about the risk of incontinence after RARP makes more patients reconsidering their initial treatment preference. The CPRED correlated strongly with continence outcome after RARP and is a useful tool for shared decision-making.
前列腺切除术后尿失禁风险的个体化信息可以帮助患者进行共同决策。
我们比较了一组历史对照队列（n=254；2016 年 6 月至 2017 年），该队列接受了机器人辅助根治性前列腺切除术（RARP）后尿失禁风险的标准化信息，以及一组前瞻性患者队列（n=254；2017 年 6 月至 2018 年 5 月），该队列根据失禁预测工具（CPRED）接受了术后 6 个月内失禁恢复机会的个体化信息。我们测量了两组患者治疗选择的变化、健康相关生活质量（QoL）以及 CPRED 工具的准确性。
RARP 作为初始治疗选择的个体化信息组患者比接受标准化信息的患者更频繁地改变治疗选择（16%比 5%；p=0.001）。有高失禁风险且 RARP 作为初始治疗选择的个体化信息组患者比中/低失禁风险患者更频繁地改变治疗选择（35%比 9.8%；p=0.001）。在接受个体化信息后选择 RARP 的低失禁风险患者在术后任何时候使用一天以上尿布的可能性较小（p=0.001），而中/高失禁风险患者则较少。与 RARP 后有尿失禁的患者相比，RARP 后 6 个月和 12 个月有尿失禁的患者总体 QoL 更差（分别为；p<0.0001 和 p=0.007）。
RARP 后尿失禁风险的个体化信息使更多的患者重新考虑其初始治疗选择。CPRED 与 RARP 后失禁结果密切相关，是共同决策的有用工具。
