Krughoff Kevin, Peterson Andrew C
Oregon Urology Institute, Springfield, Oregon.
Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
J Urol. 2023 May;209(5):981-991. doi: 10.1097/JU.0000000000003194. Epub 2023 Jan 30.
For male cancer survivors, the combination of stress urinary incontinence and recurrent bladder neck contracture presents a management dilemma with poor consensus. Our objective was to assess the impact of artificial urinary sphincter placement on bladder neck contracture recurrence among prostate cancer survivors with stress urinary incontinence and bladder neck contracture.
Men electing artificial urinary sphincter placement at our institution undergo synchronous bladder neck contracture treatment if indicated. An institutional database was queried for men with stress urinary incontinence and ≥1 intervention for bladder neck contracture. Records were divided according to whether an artificial urinary sphincter was ever placed. The impact of artificial urinary sphincter placement on bladder neck contracture recurrence was assessed using a multivariable conditional survival analysis, with survival defined as the recurrence-free interval following bladder neck contracture intervention. The proportional hazards assumption was assessed on the basis of Schoenfeld residuals.
The analytic cohort consisted of 118 in the artificial urinary sphincter group and 88 in the non-artificial urinary sphincter group. Patients in both groups underwent a median of 2 (range 1-8) bladder neck contracture interventions over the entire course of their care, encompassing 445 total bladder neck contracture interventions. The artificial urinary sphincter group was on average 2.6 years younger ( = .02) and had a higher pack-year smoking history ( < .01). The presence of an artificial urinary sphincter was associated with a 61% lower bladder neck contracture re-intervention rate (HR 0.39, < .01, CI 0.30-0.50) at any time when accounting for number of prior bladder neck contracture interventions and bladder neck contracture risk factors.
Artificial urinary sphincter placement is associated with a lower rate of bladder neck contracture re-intervention. Artificial urinary sphincter placement should not be delayed or avoided due to the presence of bladder neck contracture.
对于男性癌症幸存者而言，压力性尿失禁和复发性膀胱颈挛缩并存的情况给治疗带来了难题，且目前对此缺乏共识。我们的目标是评估人工尿道括约肌植入对患有压力性尿失禁和膀胱颈挛缩的前列腺癌幸存者膀胱颈挛缩复发的影响。
在我们机构选择植入人工尿道括约肌的男性患者，若有指征则同时接受膀胱颈挛缩治疗。查询机构数据库，筛选出患有压力性尿失禁且接受过≥1次膀胱颈挛缩干预的男性患者。根据是否植入过人工尿道括约肌对记录进行分类。使用多变量条件生存分析评估人工尿道括约肌植入对膀胱颈挛缩复发的影响，生存定义为膀胱颈挛缩干预后的无复发间隔时间。基于Schoenfeld残差评估比例风险假设。
分析队列包括人工尿道括约肌组的118例患者和非人工尿道括约肌组的88例患者。两组患者在整个治疗过程中膀胱颈挛缩干预的中位数均为2次（范围1 - 8次），总共进行了445次膀胱颈挛缩干预。人工尿道括约肌组患者平均年龄小2.6岁（P = 0.02），且有更高的吸烟包年史（P < 0.01）。在考虑既往膀胱颈挛缩干预次数和膀胱颈挛缩风险因素的情况下，人工尿道括约肌的存在与膀胱颈挛缩再次干预率在任何时候均降低61%相关（风险比0.39，P < 0.01，置信区间0.30 - 0.50）。
人工尿道括约肌植入与膀胱颈挛缩再次干预率较低相关。不应因存在膀胱颈挛缩而延迟或避免植入人工尿道括约肌。
