Püllen Lukas, Naumann Max, Krafft Ulrich, Püllen Felix, Mahmoud Osama, Al-Nader Mulham, Darr Christopher, Borgmann Hendrik, Briel Christoph, Hadaschik Boris, Salem Johannes, Kuru Timur
Department of Urology, University Hospital Essen, Essen, Germany.
Department of Anesthesiology, St. Augustinus Hospital, Düren, Germany.
Cancer Rep (Hoboken). 2024 Dec;7(12):e70092. doi: 10.1002/cnr2.70092.
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%-71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
尽管不断改进，但尿失禁仍是根治性前列腺切除术（RP）最相关且降低生活质量的副作用之一。除了年龄等患者个体因素外，外科医生/中心的经验以及所采用的手术技术也起着重要作用。
呈现2022年德国最大的康复中心之一关于RP术后短期尿失禁的当前真实世界数据，并将其与该机构2016年的结果进行比较。
对2022年1394例RP术后男性患者在康复诊所入院和出院时的数据进行回顾性、单中心、单变量分析。通过在规定分级下定量测量全天尿失禁情况来评估定义为每天使用≥1片尿垫的尿失禁，并与2016年的结果进行比较。2022年共有1393例男性可用于分析，2016年为1390例。两个队列的中位年龄均为66岁，术前前列腺特异性抗原（PSA）水平存在微小差异。尽管手术方式不同，但2016年和2022年出院时短期尿失禁率无显著变化（76.9%对77.9%，p = 0.56）。2022年观察到国际泌尿病理学会（ISUP）2级患者显著增加以及向机器人手术的转变（45.5% - 71%）。虽然保留神经导致尿失禁情况显著改善（p < 0.01），但淋巴结清扫术和T分期与短期尿失禁率的任何显著增加均无关。在队列中比较年龄组，年龄>69岁的患者短期尿失禁风险最高，康复期间恢复控尿的可能性最小（p < 0.01）。在认证的前列腺癌中心接受治疗的男性短期尿失禁率显著更低（p < 0.01）。
我们的研究表明，在过去6年中德国RP术后短期尿失禁率几乎没有改善，我们的分析重现了术后尿失禁的已知风险因素，如年龄、保留神经手术和经验水平。我们得出结论，不仅要在前列腺癌治疗前仔细选择患者并为其提供咨询，还要强烈建议在认证中心进行治疗。
