Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany.
World J Urol. 2024 Aug 22;42(1):494. doi: 10.1007/s00345-024-05200-0.
To identify independent predictors of urinary continence and report early complications after radical prostatectomy (RP) in a large, contemporary German cohort.
Urinary incontinence data of patients undergoing 3-week inpatient rehabilitation (IR) after RP were prospectively assessed by 24-hr pad test and uroflowmetry at the beginning and the end of IR, respectively. Lymphoceles were assessed prospectively by ultrasound. Tumor and patient characteristics, and information on urinary leakage on initial cystography were retrospectively extracted from discharge letters and surgical reports. Regression analyses were performed to identify predictors of urinary continence at the beginning of IR.
Overall, 2,141 patients were included in the final analyses. Anastomotic leakage on the initial cystography and lymphoceles were found in 11.4% and 30.8% of patients, respectively. Intervention for a symptomatic lymphocele was required in 4.2% of patients. At the end of IR, 54.2% of patients were continent, while the median urine loss decreased to 73 g (interquartile range 15-321). Multivariable logistic regression analysis identified age and diabetes mellitus as independent negative predictors, but nerve-sparing surgery as an independent positive predictor of urinary continence (each p < 0.001). Multivariable linear regression analysis showed that 24-hr urine loss increased by 7 g with each year of life (p < 0.001), was 79 g higher in patients with diabetes mellitus (p = 0.007), and 175 g lower in patients with NS (p < 0.001).
Age, diabetes mellitus, and NS are significantly associated with continence outcomes in the early period after RP. Our analyses may help clinicians to pre-operatively counsel patients on potential surgical outcomes.
在一个大型的当代德国队列中，确定尿失禁的独立预测因素，并报告根治性前列腺切除术后（RP）的早期并发症。
通过 24 小时尿垫试验和尿流率分别在 RP 后 3 周住院康复（IR）开始和结束时对接受 3 周住院康复（IR）的患者进行尿失禁数据的前瞻性评估。通过超声前瞻性评估淋巴囊肿。从出院记录和手术报告中回顾性提取肿瘤和患者特征以及初始膀胱造影时尿漏的信息。回归分析用于确定 IR 开始时尿失禁的预测因素。
总体而言，共有 2141 例患者纳入最终分析。在初始膀胱造影中发现吻合口漏和淋巴囊肿的患者分别占 11.4%和 30.8%。需要对有症状的淋巴囊肿进行干预的患者占 4.2%。在 IR 结束时，54.2%的患者无尿失禁，而中位尿失重量减少至 73 克（四分位距 15-321）。多变量逻辑回归分析确定年龄和糖尿病为独立的负面预测因素，但神经保留手术为尿失禁的独立阳性预测因素（均 p<0.001）。多变量线性回归分析表明，每增加 1 岁，24 小时尿液丢失增加 7 克（p<0.001），糖尿病患者的尿液丢失增加 79 克（p=0.007），NS 患者的尿液丢失减少 175 克（p<0.001）。
年龄、糖尿病和 NS 与 RP 后早期的尿失禁结果显著相关。我们的分析可以帮助临床医生在术前向患者提供潜在的手术结果咨询。
