Kitamura Kosuke, China Toshiyuki, Nagata Masayoshi, Isotani Shuji, Muto Satoru, Sakamoto Yoshiro, Horie Shigeo
Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan.
Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Int J Urol. 2023 Jan;30(1):77-82. doi: 10.1111/iju.15064. Epub 2022 Oct 28.
Postoperative urinary incontinence recovery following robot-assisted laparoscopic prostatectomy is an important outcome. We investigated whether factors that affect urinary incontinence can predict the duration of postoperative incontinence recovery.
A total of 310 patients underwent robot-assisted laparoscopic prostatectomy. Continence recovery was defined as either pad-free or a safety pad only status. Univariate and multivariate analyses were performed on clinical variables to identify those that were associated with continence recovery. A scoring system to predict recovered continence was constructed using statistically significant variables. The validity of this tool was tested in a new cohort of 273 patients.
Factors associated with recovery of urinary incontinence were membranous urethral length, preservation of bilateral neurovascular bundles, and a preoperative Prostate Imaging Reporting and Data System score of ≥3 in the apex. Age was related only to incontinence recovery at 1 month. To prepare the score, weighting was performed using the estimated values. Using the developed scoring system, participants in the verification set were divided into three groups. The early recovery group had a median incontinence recovery of 4 (4-12) weeks, the medium recovery group, 12 (4-24) weeks, and the late recovery group, 24 (24-48) weeks, which was a significant difference (p < 0.001).
The applied scoring system based on preoperative factors related to incontinence and derived from patient groups was significantly associated with continence recovery time. In patients undergoing robot-assisted laparoscopic prostatectomy, our unit-weighted regression model of clinical variables can predict the duration of continence recovery.
机器人辅助腹腔镜前列腺切除术后尿失禁的恢复是一项重要的结果。我们研究了影响尿失禁的因素是否能预测术后尿失禁恢复的持续时间。
共有310例患者接受了机器人辅助腹腔镜前列腺切除术。控尿恢复定义为无需使用尿垫或仅使用安全尿垫的状态。对临床变量进行单因素和多因素分析，以确定与控尿恢复相关的因素。使用具有统计学意义的变量构建一个预测控尿恢复的评分系统。在273例新患者队列中对该工具的有效性进行了测试。
与尿失禁恢复相关的因素有膜性尿道长度、双侧神经血管束的保留以及尖部术前前列腺影像报告和数据系统评分≥3。年龄仅与术后1个月时的尿失禁恢复有关。为了准备评分，使用估计值进行加权。使用所开发的评分系统，将验证集中的参与者分为三组。早期恢复组尿失禁恢复的中位数为4（4 - 12）周，中期恢复组为12（4 - 24）周，晚期恢复组为24（24 - 48）周，差异有统计学意义（p < 0.001）。
基于与尿失禁相关的术前因素并从患者群体得出的应用评分系统与控尿恢复时间显著相关。在接受机器人辅助腹腔镜前列腺切除术的患者中，我们的临床变量单位加权回归模型可以预测控尿恢复的持续时间。
