Braun A E, Washington S L, Cowan J E, Hampson L A, Carroll P R
Department of Urology, University of California, San Francisco, CA.
Department of Urology, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
Urology. 2023 Oct;180:242-248. doi: 10.1016/j.urology.2023.06.027. Epub 2023 Jul 11.
To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1year after RP.
Prostate cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB, and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures.
664/2989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve-sparing surgery (all P < .01). Cumulative incidence of SUI procedures was 1.4% at 10years after RP. Age (HR 2.68 per 10years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures. UF declined at 1year after RP, while UB and PF remained stable. UF, UB, and PF were inversely associated with number of ppd (all P < .01). Change in work status was not associated with incontinence or QoL scores.
Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on QoL.
描述根治性前列腺切除术后压力性尿失禁（SUI）的发生率、治疗情况及其对术后1年生活质量（QoL）和工作状态的影响。
从CaPSURE中选取1998年至2016年接受根治性前列腺切除术（RP）的前列腺癌患者。SUI定义为RP术后1年每天使用尿垫的情况。通过CPT编码（吊带和人工括约肌）追踪SUI手术情况。患者报告工作状态（全职、兼职、无薪）、加州大学洛杉矶分校前列腺癌指数尿功能（UF）和困扰程度（UB）以及SF36指数身体功能（PF）。评估尿失禁与UF、UB、PF以及工作状态变化之间的关联（方差分析）。生命表估计和Cox比例风险回归评估接受SUI手术的风险。
664/2989（22%）接受RP治疗的男性在术后1年报告有SUI。更多有SUI的男性患有≥GG2级、中高危疾病且未进行神经保留手术（所有P <.01）。RP术后10年SUI手术的累积发生率为1.4%。年龄（每10岁HR 2.68，95% CI 1.41 - 5.08）和术后1年每天使用尿垫的数量（HR 3.20，95% CI 2.27 - 4.50）与接受SUI手术相关。RP术后1年UF下降，而UB和PF保持稳定。UF、UB和PF与每天使用尿垫的数量呈负相关（所有P <.01）。工作状态的变化与尿失禁或QoL评分无关。
尿失禁影响生活质量但不影响工作状态，这表明RP术后患有SUI的男性尽管生活质量受到影响，但仍可能继续工作且治疗不足。
