Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA.
University of Virginia School of Medicine, Charlottesville, VA, USA.
World J Urol. 2023 Jul;41(7):1885-1889. doi: 10.1007/s00345-023-04458-0. Epub 2023 Jun 9.
Stress urinary incontinence (SUI) is a well-known adverse outcome following robotic-assisted laparoscopic prostatectomy (RALP). Although postoperative SUI has been extensively studied, little focus has been placed on understanding the natural history and impact of urgency symptoms following RALP. The UVA prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimize continence outcomes following RALP. The present study focuses on assessing urgency outcomes in this cohort.
PFOP patients with a minimum of 6-months follow up following RALP were included. The PFOP includes prospectively assessed incontinence and quality of life outcomes utilizing ICIQ-MLUTS, Urgency Perception Score (UPS), and IIQ-7 questionnaires. The primary study outcome was urgency urinary incontinence (UUI) as determined by ICIQ-MLUTS UUI domain. Secondary outcomes included urgency (UPS score) and quality of life (IIQ-7).
Forty patients were included with median age 63.5 years. Fourteen (35%) patients reported UUI at baseline. UUI and QOL scores worsened compared to baseline at all time-points. Urgency worsened at 3-weeks and 3-months but returned to baseline by 6-months. Notably, 63% of patients without baseline UUI reported de-novo UUI at 6 months. Although QOL was lower in patients with versus without UUI (IIQ-7 score 3.0 vs 0.0, p = 0.009), severity of UUI was not associated with QOL when controlling for SUI severity.
Our data demonstrate significantly worsened UUI from baseline and a large incidence of de-novo UUI following RALP. Further study is needed to inform how urgency and UUI and its treatment affect health-related quality of life following RALP.
机器人辅助腹腔镜前列腺切除术（RALP）后出现压力性尿失禁（SUI）是一种众所周知的不良后果。尽管术后 SUI 已被广泛研究，但对 RALP 后急迫症状的自然史和影响关注甚少。UVA 前列腺切除术功能结果计划（PFOP）旨在全面评估和优化 RALP 后的控尿结果。本研究侧重于评估该队列中的急迫症状结果。
纳入至少在 RALP 后 6 个月随访的 PFOP 患者。PFOP 前瞻性评估了 ICIQ-MLUTS、急迫感知评分（UPS）和 IIQ-7 问卷的尿失禁和生活质量结果。主要研究结果是 ICIQ-MLUTS UUI 域确定的急迫性尿失禁（UUI）。次要结果包括急迫性（UPS 评分）和生活质量（IIQ-7）。
40 例患者入组，中位年龄 63.5 岁。14 例（35%）患者在基线时报告有 UUI。与基线相比，UUI 和 QOL 评分在所有时间点都恶化。急迫性在 3 周和 3 个月时恶化，但在 6 个月时恢复到基线。值得注意的是，63%的基线时无 UUI 的患者在 6 个月时报告出现新发 UUI。尽管有 UUI 的患者的 QOL 低于无 UUI 的患者（IIQ-7 评分 3.0 对 0.0，p=0.009），但在控制 SUI 严重程度后，UUI 的严重程度与 QOL 无关。
我们的数据表明，RALP 后 UUI 从基线显著恶化，新发 UUI 的发生率很高。需要进一步研究，以了解 RALP 后急迫症状和 UUI 及其治疗如何影响健康相关生活质量。
