Fowler F J, Barry M J, Lu-Yao G, Wasson J, Roman A, Wennberg J
Center for Survey Research, University of Massachusetts-Boston, USA.
Urology. 1995 Jun;45(6):1007-13; discussion 1013-5. doi: 10.1016/s0090-4295(99)80122-8.
To assess patient responses to radical prostatectomy and its effects.
A national sample was taken of 1072 Medicare patients who underwent radical prostatectomy for prostate cancer (1988 through 1990) by mail, telephone, and personal interviews. The effects of the surgery and its complications on these patients' lives were studied through: (1) patient ratings of the extent to which sexual and urinary dysfunctions were "problems" in their lives; (2) two general measures of quality of life, the Mental Health Index and the General Health Index; (3) patient reports of how they felt about the results of treatment and whether they would choose surgery again.
On average, dripping urine, particularly to the point where subjects were wearing pads, had a more significant effect on patients than loss of sexual function; incontinence had significant adverse effects on the measures of quality of life and self-reported results of surgery. Overall, postsurgical patients scored comparatively high on the quality of life measures (similar to a cohort of patients with benigh prostatic hyperplasia who had undergone transurethral resection of the prostate), reported feeling positive about the results (81%), and would choose surgical treatment again (89%). Nonetheless, there was variability in patient response to the effects of surgery.
The results demonstrate the ability of many Medicare patients to adapt to adverse outcomes, such as loss of sexual function and incontinence. They also provide evidence of the variability of individual patients' responses to surgical results and reinforce the importance of individualized decision making for patients facing a decision about radical prostatectomy for prostate cancer.
评估患者对根治性前列腺切除术的反应及其效果。
通过邮件、电话和个人访谈，对1988年至1990年期间接受前列腺癌根治性前列腺切除术的1072名医疗保险患者进行全国抽样。通过以下方式研究手术及其并发症对这些患者生活的影响：（1）患者对性功能和排尿功能障碍在其生活中成为“问题”的程度进行评分；（2）两种生活质量综合测量指标，即心理健康指数和总体健康指数；（3）患者报告他们对治疗结果的感受以及是否会再次选择手术。
平均而言，尿液滴沥，尤其是到了患者需要使用护垫的程度，对患者的影响比性功能丧失更为显著；尿失禁对生活质量测量指标和自我报告的手术结果有显著的不利影响。总体而言，术后患者在生活质量测量指标上得分相对较高（类似于一组接受经尿道前列腺切除术的良性前列腺增生患者），报告对结果感觉良好（81%），并且会再次选择手术治疗（89%）。尽管如此，患者对手术效果的反应存在差异。
结果表明许多医疗保险患者有能力适应性功能丧失和尿失禁等不良后果。它们还提供了个体患者对手术结果反应存在差异的证据，并强化了面对前列腺癌根治性前列腺切除术决策的患者进行个体化决策的重要性。
