Soda Takeshi, Otsuka Hikari, Koike Shuhei, Okada Takuya
Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan.
Int Urol Nephrol. 2024 Mar;56(3):989-997. doi: 10.1007/s11255-023-03859-9. Epub 2023 Oct 31.
To determine baseline factors and surgical procedures associated with clinically meaningful improvement or deterioration of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP).
We retrospectively reviewed our RARP database and analyzed the changes in the International Prostate Symptom Score (IPSS) at baseline and 1, 3, 6, and 12 months postoperatively. Multivariable ordinal logistic regression analysis was performed to determine variables that predicted clinically meaningful improvement (∆IPSS ≤ -5) or deterioration (∆IPSS ≥ 5) in LUTS after RARP.
A total of 172 patients were eligible for analysis. Patients aged ≥ 70 reported a higher IPSS before and after RARP (all p < 0.05). Patients with a prostate volume of > 30 mL or body mass index of < 24 kg/m had worse preoperative LUTS; however, the difference disappeared after RARP. While patients with or without nerve-sparing (NS) had a similar preoperative LUTS burden, the NS group reported significantly lower IPSS than the non-NS group at all postoperative time points (p < 0.05). Twelve months after RARP, LUTS improved in 27% and worsened in 6% of patients in the NS group, compared with 20% and 24% of those in the non-NS group, respectively (p = 0.018). Preoperative IPSS (OR, 0.84; 95% CI, 0.79-0.89) and NS (OR, 0.39; 95% CI, 0.18-0.83) were independently associated with clinically meaningful changes of LUTS at 12 months after RARP.
Other than baseline LUTS severity, NS was the only independent factor associated with clinically meaningful changes in LUTS after RARP.
确定与机器人辅助根治性前列腺切除术（RARP）后下尿路症状（LUTS）出现具有临床意义的改善或恶化相关的基线因素和手术操作。
我们回顾性分析了我们的RARP数据库，并分析了基线时以及术后1、3、6和12个月时国际前列腺症状评分（IPSS）的变化。进行多变量有序逻辑回归分析以确定预测RARP后LUTS出现具有临床意义的改善（∆IPSS≤ -5）或恶化（∆IPSS≥ 5）的变量。
共有172例患者符合分析条件。年龄≥70岁的患者在RARP前后的IPSS较高（所有p < 0.05）。前列腺体积> 30 mL或体重指数< 24 kg/m²的患者术前LUTS更严重；然而，RARP后差异消失。虽然有或没有保留神经（NS）的患者术前LUTS负担相似，但NS组在所有术后时间点的IPSS均显著低于非NS组（p < 0.05）。RARP后12个月，NS组27%的患者LUTS改善，6%的患者LUTS恶化，而非NS组分别为20%和24%（p = 0.018）。术前IPSS（OR，0.84；95% CI，0.79 - 0.89）和NS（OR，0.39；95% CI，0.18 - 0.83）与RARP后12个月LUTS的具有临床意义的变化独立相关。
除了基线LUTS严重程度外，NS是与RARP后LUTS具有临床意义的变化相关的唯一独立因素。
