Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia.
Department of Urology, University of Zagreb School of Medicine, Zagreb, Croatia.
Neurourol Urodyn. 2022 Aug;41(6):1431-1439. doi: 10.1002/nau.24978. Epub 2022 Jun 7.
Urinary incontinence (UI) is one of the most common complications of radical prostatectomy (RP). Impaired urethral sphincter function is generally considered to be the most important contributing factor for UI; however, the mechanism of onset and recovery of urinary continence has not been fully elucidated. The objective of this research was to evaluate preoperative functional urethral length (FUL) and maximum urethral closure pressure (MUCP) as early continence recovery predictors after open retropubic RP (ORRP).
The research was conducted on a group of 43 patients with localized prostate cancer (PCa) in the period from July 2019 to May 2021. The urodynamic method of urethral pressure profile (UPP) was used to assess FUL and MUCP, and correlate with the postprostatectomy continence recovery. The severity of UI and bothersome were assessed using fully validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and number of pads used in 24 h. Patients were interviewed about the use of urinary pads and asked to fill out the ICIQ-UI SF before and 2, 8, 16 and 24 weeks after ORRP.
The median value of FUL (mm) and MUCP (cmH2O) was 69 (28-94) and 76 (16-223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FUL and MUCP with ICIQ symptom score and the number of pads used per day at the four observed time intervals (p < 0.05). Such a result showed that patients with higher preoperative FUL and MUCP values were more likely to recover urinary continence earlier. A value of 65 mm for FUL and 80 cmH O for MUCP proved to be the cut-off values for continence recovery in 24 weeks after ORRP.
Preoperatively evaluated FUL and MUCP seem to be valuable prognostic factors for early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to evaluate the role of UPP in the preoperative management of patients with PCa.
尿失禁（UI）是根治性前列腺切除术（RP）后最常见的并发症之一。尿道括约肌功能受损通常被认为是导致 UI 的最重要因素；然而，尿控的发病和恢复机制尚未完全阐明。本研究旨在评估术前功能性尿道长度（FUL）和最大尿道闭合压（MUCP）作为开放式耻骨后 RP（ORRP）后早期控尿恢复的预测指标。
本研究纳入了 2019 年 7 月至 2021 年 5 月期间 43 例局限性前列腺癌（PCa）患者。采用尿道压力剖面图（UPP）尿动力学方法评估 FUL 和 MUCP，并与前列腺切除术后控尿恢复相关。采用经过充分验证的国际尿失禁咨询问卷-尿失禁简短问卷（ICIQ-UI SF）和 24 小时内使用的尿垫数量评估 UI 的严重程度和困扰。对患者进行尿垫使用情况访谈，并在 ORRP 前及术后 2、8、16 和 24 周时要求患者填写 ICIQ-UI SF。
FUL（mm）和 MUCP（cmH2O）的中位数分别为 69（28-94）和 76（16-223）。相关性和线性回归显示，术前 FUL 和 MUCP 值与 ICIQ 症状评分和术后 4 个观察时间点的每日尿垫使用量呈显著负相关（p<0.05）。这一结果表明，术前 FUL 和 MUCP 值较高的患者更有可能更早恢复尿控。FUL 为 65mm 和 MUCP 为 80cmH2O 时，可作为 ORRP 后 24 周内控尿恢复的截止值。
术前评估的 FUL 和 MUCP 似乎是 ORRP 后早期控尿恢复的有价值的预后因素。需要进一步对更大的患者队列进行研究，以评估 UPP 在 PCa 患者术前管理中的作用。
