Yan Ye, Li Xiaolong, Xia Haizhui, Zhu Xuehua, Zhang Yuting, Zhang Fan, Liu Ke, Liu Cheng, Ma Lulin
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Aug 18;56(4):589-593. doi: 10.19723/j.issn.1671-167X.2024.04.007.
To analyze the incidence and progression of overactive bladder (OAB) symptoms following radical prostatectomy for prostate cancer patients and to identify related risk factors.
A retrospective study was conducted on 263 local stage prostate cancer patients who underwent radical prostatectomy at Peking University Third Hospital from January 2013 to May 2017. Clinical baseline information, comprehensive imaging features, perioperative parameters, preoperative urinary control status, pathological diagnosis, and the incidence of OAB within one year postoperatively were collected and analyzed. In the imaging features, two parameters were defined: Bladder wall thickness (BWT) and bladder mucosal smoothness (BMS), which were used to predict the occurrence of OAB. Patients were evaluated based on their clinical baseline characteristics, including age, body mass index (BMI), comorbidities, and prostate-specific antigen (PSA) levels. The imaging characteristics were assessed using preoperative MRI, focusing on BWT and BMS. Perioperative parameters included operative time, blood loss, and length of hospital stay. The OAB symptoms were assessed using the overactive bladder symptom score (OABSS) and the international prostate symptom score (IPSS). These scores were correlated with the postoperative incidence of OAB.
Among the 263 patients who underwent radical prostatectomy, 52 (19.8%) exhibited OAB within one year postoperatively. Of the 40 patients with preoperative OAB symptoms, 17 (42.5%) showed remission postoperatively, while 23 (57.5%) had persistent symptoms. Additionally, 29 patients developed new-onset OAB, accounting for 55.77% of all postoperative OAB cases. Univariate analysis indicated that BWT, BMS, OABSS, and IPSS score were all associated with the occurrence of postoperative OAB. Further multivariate analysis identified BMS as an independent risk factor for long-term OAB ( < 0.001).
Long-term postoperative overactive bladder is a common complication following radical prostatectomy. The findings suggest that preoperative MRI measurements of bladder wall thickness and bladder mucosal smoothness during bladder filling phase can predict the risk of OAB occurrence postoperatively. Identifying these risk factors preoperatively can help in counseling patients about potential complications and in developing strategies to mitigate the risk of developing OAB after surgery. Early detection and management of these parameters might improve the quality of life for patients undergoing radical prostatectomy.
分析前列腺癌患者根治性前列腺切除术后膀胱过度活动症（OAB）症状的发生率及进展情况，并确定相关危险因素。
对2013年1月至2017年5月在北京大学第三医院接受根治性前列腺切除术的263例局限性前列腺癌患者进行回顾性研究。收集并分析临床基线信息、综合影像特征、围手术期参数、术前排尿控制情况、病理诊断以及术后一年内OAB的发生率。在影像特征方面，定义了两个参数：膀胱壁厚度（BWT）和膀胱黏膜平整度（BMS），用于预测OAB的发生。根据患者的临床基线特征进行评估，包括年龄、体重指数（BMI）、合并症和前列腺特异性抗原（PSA）水平。使用术前MRI评估影像特征，重点关注BWT和BMS。围手术期参数包括手术时间、失血量和住院时间。使用膀胱过度活动症症状评分（OABSS）和国际前列腺症状评分（IPSS）评估OAB症状。这些评分与术后OAB的发生率相关。
在接受根治性前列腺切除术的263例患者中，52例（19.8%）在术后一年内出现OAB。术前有OAB症状的40例患者中，17例（42.5%）术后症状缓解，23例（57.5%）症状持续。此外，29例患者出现新发OAB，占所有术后OAB病例的55.77%。单因素分析表明，BWT、BMS、OABSS和IPSS评分均与术后OAB的发生有关。进一步的多因素分析确定BMS是长期OAB的独立危险因素（<0.001）。
术后长期膀胱过度活动症是根治性前列腺切除术后常见的并发症。研究结果表明，在膀胱充盈期通过术前MRI测量膀胱壁厚度和膀胱黏膜平整度可以预测术后OAB发生的风险。术前识别这些危险因素有助于向患者咨询潜在并发症，并制定降低术后发生OAB风险的策略。早期检测和管理这些参数可能会改善接受根治性前列腺切除术患者的生活质量。
