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糖尿病会降低接受根治性前列腺切除术的前列腺癌患者短期尿失禁恢复的几率。

Diabetes mellitus lowers the chance of short-term urinary continence recovery in prostate cancer patients undergoing radical prostatectomy.

作者信息

Philippi Alexander, Mandel Philipp, Hohenhorst Jan L, Wenzel Mike, Humke Clara, Wittler Clarissa, Köllermann Jens, Steuber Thomas, Graefen Markus, Tilki Derya, Karakiewicz Pierre I, Preisser Felix, Becker Andreas, Kluth Luis A, Chun Felix K H, Hoeh Benedikt

机构信息

Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

出版信息

Cent European J Urol. 2022;75(2):162-168. doi: 10.5173/ceju.2022.0279.R1. Epub 2022 Jun 4.

Abstract

INTRODUCTION

The aim of this article was to test the impact of diabetes mellitus (DM) on short-term urinary continence in patients undergoing radical prostatectomy (RP).

MATERIAL AND METHODS

We relied on an institutional tertiary-care database to identify patients who underwent RP between 11/2018 and 02/2021 with data available on short-term urinary continence status (30-90 days post-surgery). Continence was defined as the usage of no or one safety-pad within 24 hours. Univariable and multivariable logistic regression models tested the correlation between DM and short-term continence. Covariates consisted of pathological T-stage, body mass index, prostate volume, surgical approach and nerve-sparing.

RESULTS

Of 142 eligible patients, 15 (11%) patients exhibited concomitant DM. Patients diagnosed with DM exhibited lower continence rates at short-term follow-up compared to patients without DM (33 vs 63%, p = 0.03). In univariable and multivariable logistic regression models, DM was strongly associated with reduced chances of short-term urinary continence recovery (multivariable odds ratio [OR]: 0.26, 95%-CI: 0.07-0.86; p = 0.03). Furthermore, pathological T-stage (pT3/pT4) was additionally associated with reduced chance of urinary continence in logistic regression models (multivariable OR: 0.43, 95%-CI: 0.19-0.94; p = 0.04). Other covariables failed to reach statistical significance in multivariable logistic regression analyses predicting urinary continence.

CONCLUSIONS

DM was associated with lower chances of short-term urinary continence recovery in a contemporary cohort of patients undergoing radical prostatectomy. Patients with DM should be preoperatively informed and intensified, postoperative pelvic floor training should be considered in this subgroup of RP patients.

摘要

引言

本文旨在测试糖尿病(DM)对接受根治性前列腺切除术(RP)患者短期尿失禁的影响。

材料与方法

我们依据一个机构三级医疗数据库,识别出在2018年11月至2021年2月期间接受RP且有短期尿失禁状态(术后30 - 90天)数据的患者。尿失禁定义为24小时内使用不超过一片安全护垫。单变量和多变量逻辑回归模型测试了DM与短期尿失禁之间的相关性。协变量包括病理T分期、体重指数、前列腺体积、手术方式和神经保留情况。

结果

在142例符合条件的患者中,15例(11%)患者合并DM。与无DM的患者相比,诊断为DM的患者在短期随访中尿失禁发生率较低(33%对63%,p = 0.03)。在单变量和多变量逻辑回归模型中,DM与短期尿失禁恢复机会降低密切相关(多变量优势比[OR]:0.26,95%置信区间[CI]:0.07 - 0.86;p = 0.03)。此外,在逻辑回归模型中,病理T分期(pT3/pT4)也与尿失禁机会降低相关(多变量OR:0.43,95%CI:0.19 - 0.94;p = 0.04)。在预测尿失禁的多变量逻辑回归分析中,其他协变量未达到统计学意义。

结论

在当代接受根治性前列腺切除术的患者队列中,DM与短期尿失禁恢复机会较低相关。应在术前告知DM患者,并考虑对该RP患者亚组加强术后盆底训练。

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