Duke University School of Medicine, Durham, NC.
Department of Urology, Lahey Hospital & Medical Center, Burlington, MA.
Urology. 2022 Aug;166:257-263. doi: 10.1016/j.urology.2022.03.041. Epub 2022 May 16.
To investigate the impact of pelvic exenteration (PelvEX) on patient-reported pain, distress, and quality of life along with physiologic indicators of health in cancer survivors with radiated, non-repairable rectourethral fistula (RUF).
We reviewed a prospectively maintained quality improvement database of RUF patients at our institution from 2012 to 2020. Patients with radiated, non-repairable RUF who underwent PelvEX and had follow up to 1 year were included. Pain and distress scores were collected preoperatively and at 1-year follow up. Number of narcotic prescriptions in the 3 months before surgery and the year after surgery were abstracted. Short Form 12 surveys were administered in the postoperative period. Serum albumin, creatinine, carbon dioxide, hematocrit, and glucose were abstracted from electronic health records. Statistical analysis was performed using Wilcoxon signed-rank and Mann-Whitney tests.
Eleven patients met inclusion criteria. Patient-reported pain significantly decreased at 1 year follow-up compared to preoperative scores (median pre: 4 vs 1 year post: 0, P = .0312). Patient-reported distress significantly decreased pre- versus post-PelvEX (median pre: 5 vs post: 0, P = .0156). At the time of postoperative pain and distress surveys, 9 (82.8%) patients did not have narcotic prescriptions. Postoperative Short Form 12 scores were similar to an age-matched United States population (mental: P = .3125; physical: P = .1484). Serum-based indicators of health were not different in the pre- versus postoperative period (all P >.05).
PelvEX may be a valuable treatment option to decrease patient-reported pain and distress without compromising quality of life or physiologic health in patients with radiated, non-repairable RUF.
研究盆腔廓清术（PelvEX）对放射治疗后不可修复的直肠尿道瘘（RUF）患者的疼痛、痛苦和生活质量以及健康生理指标的影响。
我们回顾了 2012 年至 2020 年我院 RUF 患者前瞻性维护的质量改进数据库。纳入接受 PelvEX 治疗且随访时间达 1 年的放射治疗后不可修复的 RUF 患者。收集患者术前和术后 1 年的疼痛和痛苦评分。从术前 3 个月和术后 1 年的手术麻醉处方数量中提取。术后期间进行简明健康调查问卷 12 项（Short Form 12）调查。从电子病历中提取血清白蛋白、肌酐、二氧化碳、红细胞压积和血糖。使用 Wilcoxon 符号秩和检验和 Mann-Whitney 检验进行统计学分析。
11 例患者符合纳入标准。与术前评分相比，患者报告的疼痛在术后 1 年随访时显著降低（中位数术前：4 分 vs 术后 1 年：0 分，P = 0.0312）。患者报告的痛苦在 PelvEX 前后显著降低（中位数术前：5 分 vs 术后：0 分，P = 0.0156）。在术后疼痛和痛苦调查时，9（82.8%）例患者没有麻醉处方。术后简明健康调查问卷 12 项评分与美国年龄匹配人群相似（心理：P = 0.3125；身体：P = 0.1484）。术前和术后期间健康的血清指标无差异（均 P > 0.05）。
对于放射治疗后不可修复的 RUF 患者，PelvEX 可能是一种有价值的治疗选择，可以降低患者报告的疼痛和痛苦，而不会影响生活质量或生理健康。
