Del Giudice Francesco, Huang Jianlin, Li Shufeng, Sorensen Simon, Enemchukwu Ekene, Maggi Martina, Salciccia Stefano, Ferro Matteo, Crocetto Felice, Pandolfo Savio Domenico, Autorino Riccardo, Krajewski Wojciech, Crivellaro Simone, Cacciamani Giovanni E, Bologna Eugenio, Asero Vincenzo, Scornajenghi Carlo, Moschini Marco, D'Andrea David, Brown David R, Chung Benjamin I
Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):367-373. doi: 10.1038/s41391-022-00558-x. Epub 2022 Jun 21.
To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI).
We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.
Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery.
The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.
确定根治性前列腺切除术后尿失禁（PPI）不同手术方法的使用趋势、成本及预测因素。
我们纳入了2003年至2017年期间被诊断为局限性前列腺癌（PCa）并接受根治性前列腺切除术（RP）的21589名男性。主要结局是尿失禁手术的实施情况。查询了Optum的去识别化临床信息数据集市数据库以确定感兴趣的队列。获取并比较了不同尿失禁手术的平均成本。此外，通过多变量回归分析评估了尿失禁手术的人口统计学和临床预测因素。
在21589名接受RP治疗的局限性PCa男性中，740名（3.43%）在中位随访5年期间至少接受了一次尿失禁手术。总共进行了844例不同的尿失禁手术。男性吊带是最常见的手术（47.5%），与其他治疗选择相比成本适中，并且是大多数患者（50%）的首选治疗方法。人工尿道括约肌（AUS）的使用是第二常见的（35.3%），但也是最昂贵的治疗方法，并且是32.3%患者的首选治疗方法。多变量分析显示，代谢综合征相关疾病、辅助/挽救性放疗以及神经科合并症病史与尿失禁手术可能性增加独立相关。
男性吊带的使用先增加后减少，而AUS的使用稳定，尿道填充剂的使用不常见。从成本角度来看，AUS是最昂贵的选择。最后，发现患者的合并症病史和RP相关因素会影响初次或后续PPI干预的选择。
